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Full text of "Shanghai hygiene, or, Hints for the preservation of health in China"

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CHARLES WILLIAM WASON 
COLLECTION 

CHINA AND THE CHINESE 



THE GIFT OF 

CHARLES WILLIAM WASON 

CLASS OF 1876 

1918 



Cornell University Library 
RA 902.S52H49 




3 1924 023 608 460 




The original of tliis book is in 
tine Cornell University Library. 

There are no known copyright restrictions in 
the United States on the use of the text. 



http://www.archive.org/details/cu31924023608460 



SHANGHAI HYGIENE. 



OR 



HINTS FOR THE PRESERVATION 



OF 



HEALTH IN CHINA 



BY 



JAMES HENDERSON, M. D. 



"Rebum cogkosceke causas, medicis impkimis hecessakium, sine quo, 

SEC JIORBDM CUBAKE, KEO PRieOAVEEE POTEST." 



SHAEGHAI: 

TRESEYTIIRIAN MISSION PRESS. 
1803. 



PREFACE, 



Among several valuable Works, bearing on the prevention 
and treatment of disease in and near the Tropics, -written 
for professional men; I am not aware of any work on these 
important subjects, which could aid, or be of much use to the 
general reader. This is a great mistake, considering that a 
man's health and life are involved in the consequences; and 
though some know better and do worse, yet it is always safe, 
and frequently successful, to appeal to the reason and com- 
mon sense of an Englishman, and to place the real facts, or 
the truth before him, and let him judge for himself. This 
I have tried to do in the following pages. It will be observed 
that I have availed myself largely of the mature experience, 
an:Laccurate observation of the best Authorities, men who have 
devoted their time, talents, and life, to the practical study 
of these matters, My own remarks are also made after much 
consideration, and some experience of the diseases peculiar to 
this region, and after carefully observing the effects of this 
climate on European constitutions. I have been particularlv 
careful not to admit opinions or propositions to be facts, 
before submitting them to the most strict and rigorous exam- 
ination; and in the practical investigation of the subjects 
trea,ted in these pages, over a wide field of medical observation 
and inquiry, I have constantly striven never to forget or 
disregard a single fact, however unimportant it appeared at 
the time of its discovery; but being once satisfied of hav- 
ing found these facts or truths, I have always, when 
practicable made them motives of action, and mainsprings 
of conduct in treating disease. The great Cullen remarked 
that there are more false facts, than false theories in medi- 
cine; and I need not say how much confusion has arisen, or 
how much mischief has been done, or how many lives have 
been lost, by admitting as facts what were only theories or 
opinions. 



IT PREFACK. 

My aim has been to place before the reader, in as few words 
as possible, a plain and reasonable statement of what is al- 
ready well known and established, in the science and literature 
of Hygienic Medicine. 

I have not said anything of the treatment of disease; for 
while prevention is within the reach of all, and ought to be 
studied and practised by all, safe and successful treatment 
must always be confined to Medical men. 

Finally, should any one say that what I have written is 
infra dignitatem professionally — I reply in the words of a 
distinguished Author. "I myself am a man, and nothing 
that concerns man is below my notice." 

J. H. 

Shanghai 
June IGth, 1863. 



CONTENTS. 



■ Page. 

Diet ..- ..3 

Drink _ 22 

Exercise ..35 

Clothixc, 37 

Bathing 41 

Perspiration 46 

Lichen Tropicus 48 

The Liver 49 

Sleep ^ 59 

The Passions 61 

General Remarks — 70 



SHANGHAI HYGIENE. 



I have never met a man who had not some rules or notions, 
more or less definite ahout preserving his health, or prevent- 
ing disease. The common sense of most men and most na- 
tions leads them to adopt certain means, however vague, which 
tend they hope, to preserve health, and prolong life. 

Hygienic rules however, are like vital points in religion and 
. morals, most men agree in them, but nearly all, transgress, 
forget, or disregard them. 

Now, I consider that it is juist as much the duty of the 
Physician to lay down rules for preserving health, and pre- 
venting- disease, and death in a community, as for a preacher, 
or a moralist to raise his voice against crime; more especially 
when the Physician feels convinced that much can be done, and 
sees that little is done, to prevent disease; nay, that much is 
done by many which is utterly incompatible with, and op- 
posed to, the preserva'tion of health; when he is asked move- 
over, by his countrymen, who have left home and friends for a 
few years* — ,have left in short all they hold dear on earth, — all 
they care to live for — and are anxious to find out how they 
may live five or ten years in a locality where many have found 

* The English youth leaves his native shores with vigorous health and buoy- 
ant spirits, for a foreign land of promise, where he is to meet with adventures, ac- 
quire fame, and realize a foriune. Ail the happy events (real or ideal) of his 
journey through lite, are painted by his ardent imagination in prominent charac- 
ters, on the foreground of the scene; while reverses, sickness, disappointments 
death itself, are all thrown into the shade, or, if suffered to intrude, only serve 
as incentives to the pursuit which has been commenced. — 

Dk. J.lJIliS JuH.Mtio.-^. 



■I rilfeAX(JIIAI HVtaiLNE. 

an early j^'nive, and which Ih well known to be less healthy 
than their own country, and consequently requires more cau- 
tion on their part. — What is the best method of preserving 
health in Shanghai?. I feel therefore, that if I can by a few 
simple rules aid such men, my chief aim will be attained. 

Lord Bacon exhorts medical men to "exert themselves for 
the general good, and raise their minds above the sordid con- 
siderations of cure, not deiiving their honours from the neces- 
sities of mankind, but becoming ministers of the Divine 
power and goodness, both in prolonging and restoring the life 
of man". 

In the CyclopEedia of Xenophon also, the preservation of 
health is declared "a noble art worthy of Cyrus himself 

Descartes evidently felt, that whatever 1 ended to improve 
the physical constitution of man, niuat promote general hap- 
piness and improve virtue, for in one place he writes. S'il 
est possible de perfectionner I'espece humaine, c'est dans la 
medicine q'il faut en chercher les moyens". In a j^aper read 
before the North China Branch of the Koyal Asiatic Society, 
I referred to the striking facts regarding the mortality of the 
English troops at Hong-Kong, in the years 1842 — 3 — 4, which 
was from 19 to 22 per cent, or from 190 to 220 per 1000, 
while subsequently, when more was known of the locality, and. 
measures were adopted to preserve the soldier's health, the 
mortahty fell, first to 8i per cent, or 85 per 1000, and at 
last to 2i per cent, or 25 per 1000 : and I cannot help think- 
ing, that of the 1.600 Europeans who died last year in Shang- 
hai, a thousand at least might have been alive now, had care 
been taken, and due prophylactic measures adopted to preserve 
health.* 

Dr. Farr says, "in the Science of health there are more 
exact demonstrable truths than in the science of disease, and 
the advantages of prevention o\er cure, require no proof". 

"Hygiene", says Gabanis, "teaches the means of preser dug 
health, and forms an important branch of moral as well as 

■^ Referring to what prophylactic measures and hygienic rules have Jone, 
Dr. John Brown says "There never were so few deaths per annum as at present. 
At the Mauritius and Ceylon, the mortality has fallen from forty three and 
six-tenths, to twenty two and one-third per 1000 — nearly one half. While in the 
East aud West Indies and the Cape, in spite of pestilence and war the diminu- 
tion of deaths is most strongly marked.'' 



SHANOHAI IIYOIIWE. .3 

medical science. Ethics being in fact but the science of Ufa, 
how is it possible for this science to be complete without a 
knowledge of the changes which the subject to which it is ap- 
plied may experience, and without a knowledge of the means 
by which their changes are effected. The study of nature is 
in general a study of facts, not of causes. For studying the 
healthy and diseased states, for tracing the progress and de- 
velopement of any particular disease, we have no occasion to 
know the essence of life, or that of the morbific cause. Obser- 
vation, experience, and reasoning are sufficient for our pur- 
• poses, we req[uire nothing more". 

Nothing seems more touching than to see a man prostrated 
with disease, or on a death bed far removed from home and 
friends. A man's health is his best" fortune, for what is for- 
tune without health? A man will do much to save his for- 
tune, why shauld he not do something to preserve health and 
save his life? 

The following arguments and rules will be drawn from ma- 
ny sources, from the observation and experience of Medical 
writers, both English and Continental. In regard however to 
that which immediately concerns Shanghai and all jjertaining 
to it, I shall give my own experience, facts, and observations, 
which embrace a period of several year's study of the diseases 
peculiar to this region, and the influence of these diseases, and 
the first and subsequent effects of this climate on Europeans. 

I may say at the outset, that an 'European with a toler- 
ably good constitution, has his health almost entirely in his 
'own keeping on arriving in Shanghai; and if he is careful in 
regard to his diet, drrnk, exercise, and clothing, he need not 
fear the climate; and as these are of the greatist importance, 
I shall say a few words on each.* 

Diet. 

Of all the various prolific sources of disease, irregularities 
of diet are the most powerful; of all the means of cure at our 
disposal, attention to the quality and quantity of the ingesta 

* In discussing these imporiant subjects I shall to a large extent follow the 
order of Dr. James Johnson, and Sir J. R. Marlin, in their excellent and 
elaborate works on the ltifl.Heiw,e of Tropical Climates on European Conslitu- 
timis. 



4 SHANGHAI HYGIENE. 

are moSt important. The quantity of food is more import- 
ant than the quality; though both require attention, especial- 
ly on arriving here during the summer or autumn months. Sir 
James Martin, whose experience extended over 20 years in 
India writes, "It is now well known from dire experience that 
instead of a disposition to debility and putrescency, a conges- 
tive and sometimes an inflammatory diathesis, with tendency to 
general or local plethora, characterizes the European and his 
diseasfci., for some years at least after his arrival between the 
tropics, and hence provident Nature endeavours to guard 
against the evil by diminishing our relish for food. But alas ! 
how pi one are we to spur the jaded appetite, not only by 
'dishes tortured from their native taste', but by more danger- 
ous stimulants of wine and other liquors, as well as by con- 
diments and spices, which should be reserved for the general 
relaxation and debility which unavoidably supervene during 
a protracted residence hi sidtry climates. Here is an instance 
where we cannot safely imitate the seasoned European, for 
there are no points of hygiene to which the attention of a new 
comer should be more particularly directed than to the 
qiiantity and simplicity of his viands. They are practical 
points within his own command". 

The condition of an Englishman arriving by P. &0. Steamer 
in Shanghai is, what many would call bordering on a state of 
disease from over repletion. For seven or eight weeks he has 
been undergoing an ordeal, or process of a most novel and 
trying kind. During the whole of the journey, from Gibraltar, 
to Hong-kong, he has been precisely in the same condition, 
and subjected to the same process, as a Strasburg goose. 
Professor Bennett says, "the manner in which the livers of 
geese are made fatty at Strasburg is as follows". "The geese 
are confined in close cages in a heated atmosphere, andlargely 
supplied with food, want of exercise, and heat, diminish the 
respiratory tunctions and cause that of the liver to be disor- 
dered, and the result is enlargement of the organ from accu- 
mulation of fat".* 

The passenger on the P. &0. Steamer is subjected to a hot 
atmosphere, supplied with food of a highly stimulating and 

* The goose is afterwards killed, the liver is taken out, and these distended 
fatty livers are the precious moneanx contained in the pUe dc foie gras. 



SHANGHAI HYGIENE. 5 

mitritioHS nature; -n-hile exercise is almost, in many cases is 
altogether suspended, and as if this were not enough to make 
a healthy man diseased, a strong man weak, or an active man 
languid and lazy, alcoholic heverages of all sorts are supplied 
ad libitum, and freely partaken of, with the impression that 
they are necessary to support the strength under a tropical 
sun, or to relieve the feeling of languor and prostration, re- 
sulting purely from over repletion. 

Those who leave England for the first time, have never be- 
fore been subjected to such a trying ordeal; on the contrary, 
in many instances the meals have been unstimulating, plain, 
and partaken of in moderation, while there has been a cer- 
tain amount of exercise in a cold bracing atmosphere. Can 
it be wondered at then, if a man accustomed to simple food, 
and 1, 2, or 3 glasses of wine daily, with plenty of exercise in 
a dry atmosphere of 50° or 60° should suifer on being sud- 
denly put upon rich savory stimulating food, drinking wine 
freely, 3 or 4 times daily, with mind and body perfectly desti- 
tute of exercise or employment, and subjected to a moist de- 
pressing atmosphere of 90° or 100°.? 

The marvel is that the system does not sink under such a 
pressure, or that the digestive organs do not suddenly stop, 
under such wanton abuse. 

The consequence of all this is, an enlarged and fatty liver. 
The carbonaceous elements of the food and drink, when the 
temperature is high, are not separated by the lungs in suffi- 
cient quantity, but are stored up in the liver in the form of fat; 
and hence fatty liver, languor, constipation, alternating with 
diarrhcEa, irritability, listlessness, and after a time, breath- 
lessness, and a puffy appearance of the skin, or sallowness re- 
sult according to individual temperament. "A high temper- 
ature" says Dr. Bennett, "and a rarified atmosphere, indispose 
persons to take bodily exercise, and the excretary power 
of the lungs being diminished, the excess of carbon in 
the tissues and food is thrown upon the liver, and there con- 
verted into fat". It is to be regretted that such a state of 
things exist. Plainer food and less variety would prove 
much more wholesome; while only light French or other con- 
tinental wines should be suj)plied. Claret, Eed Burgundy, 
Ked Hermitage, with Eed and White Ebeinish wines would 



h SHAXiiHAI HYGIENE. 

bo amply refreshing. The same rules should be observed 
during the hot season in Shanghai; food should be light, nu- 
tritious, and partaken of in sufficient quantity to support 
the system, at the same time care should be taken not to op- 
press the digestive organs or the nervous energies by stimu- 
lating food frequently repeated. I am convinced that much 
dyspepsia, languor, and a feeling of being generally out of 
sorts, and requiring a change of climate, and also troublesome 
diarrhoeas are produced by rich {ood in too great variety, and 
in too large quantity, during the hot season. Not more than 
half the amount of food is required to sustain the vital energies 
in the hot months as during the cold; but people pay no re- 
gard to this fact, but pursue the same method of diet as dur- 
ing cold weather, and the result is, that the system findjng 
itself o^jpressed by materials which it cannot use, endea- 
vours to get rid of them by other means and other channels, 
or may adopt another method, namely, induce fever, and thus 
for a time })revent more offending material being thrown in- 
to the body. 

Hir J. Martin says "He who consults his health in the 
East will b(3ware of late and heavy dinners, particularly dur- 
ing the period of probation, but will rather be satisfied with 
a light and early repast as the princi'pal meal, when tea or 
coffee, at six or seven o'clock will be found a grateful 
refreshment. After this, his rest will be as natural and refresh- 
ing as can be expected in such a climate, and he will rise in the 
morning with infinitely more vigour than if he had crowned 
a sumptuous dinner with a bottle of wine the previous even- 
ing. Let but a trial of one week put these directions to the 
test, and they will be found to have a more substantial 
foundation than theory". 

This was written for residents in India, but they are pre- 
cisely applicable for residents in Shanghai, during the sum- 
mer months. 
No doubt men with fine elastic constitutions* — and many 

* The Comlilution oi an inaividual is the inode of organizatioa proper to 
him. A man for example is said to have a robust or a delicate, or a good or a 
bad constitutioQ when he is apparently strong or frcble, usually in good health, 
or liable to frequent attacks of disease. The va-ities in constitulion are there- 
fore as numerous as the individuals themselves. A strong constitution is 
considered to be dependent upon the due developement of the princi- 



SHANGHAI HYGIENE. 7 

such are here, may /or a time proceed with impuurty, and 
set all rules at defiance, a time will arrive however, \vhen 
care will be necessary, and happy is the man who has not to 
pay for his experience with an impaired constitution. 

I could name several instances of individuals, who foolishly 
poo-poo'd every attention to diet and the preservation of 
health, who, notwithstanding their good constitution and for- 
mer robust health, fell a prey to their own presumption. 

The food during the hot weather can scarcely be too simple; 
roast mutton, beef, fowl, or fowl curry for dinner, while 
for breakfast a mutton chop, fresh eggs, curry, and bread and 
butter, with coffee or tea, or claret and water.* 

It is perfectly absurd to think that a man can enjoy 
good health through the hot season, if he eats of six eight, 
or ten different dishes during a meal, which is frequently 
done here. It is common to begin breakfast with fish, beef- 
steaks, or mutton chops with potatoes ; then follow omelets, 
then rice and curry, then eggs, or eggs and bacon, afterwards 
jam or marmalade with toast or bread. During this time one 
two or three cups of tea or coffee have been drunk, sometimes 
both, and the repast is woundup Avith a tumbler full of clar- 
et and water. 

Dr. Johnson says "The period of our meals in hot climates, 
indeed_in*all climates, is worthy of notice. Both Hindoo 
and Mahomedan breakfast early, generally about sunrise. 
Their early hours can not be too closely imitated by Europ- 
eans. This is a very substantial meal, particularly with the 
Hindoo; for rarely does he take anything else till the evening, 
a custom, that in my opinion would be very prejudicial to 
Europeans. Breakfasts among the latter are often produc- 
tive of more injury than dinners, especially, where fish, eggs, 
ham, &c. are devoured without mercy, as not unfrequently 
happens. Many a nauseous dose of medicine have I been 

pal organs of tbe body, on a happy proportion between these organs, and on a 
lit state of energy of the nervous system ; whilst the feeble or weak constitution 
results from a want of these postulates. Dunglison. P. 449. 

* The praclice of taking breakfast at 12 or 1 o'clock, adopted by many in 
Shanghai is good and wholesome; this should be the most substantial meal cf the 
day, and at seven or eight o'clock, a light tea only should be partaken of, during 
hot weather. 



8 SIlANCiHAI J{y(iIENE. 

obliged to swallow from indulging too freely in these artic- 
les; but I saw my error before it was too late. Most people 
suppose, that as a good appetite in the morning is a sign of 
health, so they cannot do sufficient honour to the breakfast 
table; but the stomach, though it may relish, is seldom equal 
to the digestion of such alimentary substances as those alluded 
to, where a sound night's rest has hardly ever been procured. 
I have seen the most unequivocal bad effects from heavy 
breakfasts in others, as well as in my own person; and I shall 
relate one instance that may well serve as a drawback upon 
the pleasiures of a luxurious dejeutie in the East. Mr. B — , 
Purser of a frigate, a gentleman well known on the station, 
was as determined a bon vivant as ever I had the honour of 
being acquainted with. "Be mortuis nil nisi verum." He cer- 
tainly had possessed a most excellent constitution; for I have 
^een it perform prodigies, and falsify the most confident me- 
dical prognostications ! He had served many years in the 
West Indies, where he passed through the usual ordeals of 
yellow fever, dysentery, &c. with eclat; and he came to the 
East with the most sovereign contempt for every maxim of 
the hygeian goddess. Although he never neglected, even by 
accident, his daily aud nightly libations to the rosy god, yet 
no sportsman on the Caledonian mountains, could do more 
justice to a Highland breakfast than he. Indeed Tie rarely 
went to sea without an ample stock of private epicurean 
provisions, and I have seen him thrown into a violent paroxy- 
sm of rage, on finding that two nice looking hams which 
he had purchased in China, resisted all attacks of the knife, 
in consequence of a caxiaSxcligneotcs principle which "Fukki" 
had contrived to substitute with admirable dexterity, for the 
more savory fibres of the porker ! The items of the last break- 
fast which he made, minuted on the spot by a German surgeon 
who attended him are now before me. The prominent arti- 
cles were, four hard boiled eggs, two dried fishes, two'plates of 
rice, with chillies, condiments, and a proportionate allowance 
of bread, butter, coffee &c. 

Many a time had I seen him indulge in this kind of fare 
with perfect impunity; but all things have an end, and this 
proved his final breakfast! He was almost inunediately 
taken ill, and continued several days in the greatest agony 



SHANGHAI HTGIENK. 9 

imaginable! Notwithstanding, all the efforts of the surgeon, 
no passage downwards could ever be procured, tiU a few hours 
before his death, when mortification released all strictures. 
Let the fate of the dead prove a warning to the living." 

It is impossible for health to continue good under such a 
system; were the atmosphere always bright and cold, and 
much exercise taken, the system might bear up, though of- 
ten hard pressed, and with frequent fits of indigestion; but 
in a hot and moist atmosphere, a few days, or weeks will lay 
the offender on his back, when, instead of regulating his own 
diet, it must now be regulated for him, and he is fortu- 
nate indeed, if he rises from his sick bed, with a system as 
sound as before he adopted such an absurd and un-natural 
mode of living; a vessel which has once fallen on the stones 
may be patched up so as to be very useful, but more care 
will be necessary than before it fell, and it is not so sound 
and strong as formerly; and so it is with a man who has once 
been prostrated with dysentery, or disease of the liver, he may 
still be a healthy, and a tolerably strong man; but not so 
strong, not such a man as he was before his illness. Men 
have no such plan of living at home, where they enjoy perfect 
health; and why should such an absurd system be carried 
on here. ^ 

I may state, that I have lived in Shanghai almost exactly 
the same as at home, with the exception of rigidly abstain- 
ing from all kinds of vegetables and fruit during the summer 
and autumn months; and I believe this to be one of the chief 
reasons of my not having had a day's illness of any kind. 
And this leads me to say a few words, about the vegetables and 
fruit of Shanghai, and other parts of China. 

In most cases, a man appears to have security against 
diarrhoea and dysentery in Shanghai, during the summer 
months, according to Ihe quantity and variety of vegetables 
and fruit which he eats; people who indulge in them during 
this season are more or less troubled with bowel complaints, 
and I may say, vice versa. 

The first summer I passed in Shanghai, my attention was 
strikingly drawn to this fact, and subsequent experience 
and observation, have confirmed what I then noticed. 



10 SHANGHAI HYGIENE. 

Almost every case of diarrhoea, dysentery, or cholera occurring 
in Shanghai during the hot months, could be traced directly, 
or indii'ectly, to indulgence in Chinese fruit or vegetables. 
I do not attempt to explain why it is so;* I merely state a 
striking fact, that has been forced upon my observation, in 
tens of cases- among Foreigners, and in hundreds of cases 
among Chinese; although the latter are certainly less suscep- 
tible than the former; but whether this is by idiosyncrasy, or 
habit, I am not prepared to say, perhaps it is both; but even 
with the Chinaman's obtuse susceptibility, when he requires 
an aperient medicine, he has recourse to some water-melon, 
(so often seen on the Foreigner's table) or to some other fruit, 
scarcely less sure in its action, f 

A knowledge, however, of the injurious effect of Chinese 
fruit in hot weather, will not always make us abstain from 
it. I attended a lady in the summer of 1861, who for many 
weeks suffered much from the effects of Shanghai fruit. After 
one or two relapses, brought on by renewed indulgence, and 
being repeatedly remonstrated with, she said', "Well doctor 
what am I to do.? The Almighty has provided these fruits for 
us, and surely they are meant to be eaten;" but this reason- 
ing did not appear to me to be conclusive, and on persisting 
that the fruit should not be eaten, she gradually recovered. 
Another argmnent brought forward is, that the fruit of any 
locality, must necessarily agree with the people of that 
locality; this however, is a theory unsupported by facts; and 
I repeat, that indulgence in Shanghai fruit, during the sum- 
mer and autumn months, is incompatible with continued 
good health among the Eesidents. 

There are doubtless some exceptions to this rule, especial- 
ly, if a man commences cautiously, he may by degrees, become 
habituated to the Chinese fruit, as one becomes habituated 
to large doses of opium, arsenic, or alcohol; but I maintain 

* May it not be owing in some measure, to the peculiar kind of manure used 
here, and all- over China, in raising fruit and vegetables^ 

I Regarding fruits in India, Dr. Jo hnson says — "Although I myself never had 
any reason to believe that they actually occasioned dysentery, yet, where the intes- 
tines are already in an irritable state, from irregular or vitiated secretions of bile, 
Lhey certainly tend to increase that irritaMlily, and consequently predispose to the com- 
plaint m question" 



SHANGHAI HYGIENE. 11 

that he is better without the fruit, i.e., his health, and life are 
more secure, if he abstains from it. It has all more or less a 
purgative influence in hot weather, and some kinds of it will 
act as surely, and on some persons, as violently as Epsom 
Salts, or Elaterium. 

The only Shanghai vegetable, which is absolutely safe dur- 
ing the hot weather, is rice, and it is quite sufficient for all 
the purposes of nutrition and good health. It contains but 
very little excrement, and may be safely eaten under all cir- 
cumstances ; and I am fully convinced, that were people to 
confine themselves to a plain joint of mutton, beef, or fowl 
with rice, or rice and curry for dinner, with two or three glas- 
ses of claret, or Kheinish wine, there would be very little 
diarrhoea, dysentery, or disordered liver, during the summer 
months in the East. Instead of this however, men in spite 
of their better knowledge and judgment, begin dinner with 
rich soup, and a glass of sherry; then they partake of one or 
two side dishes, with champagne; then some beef, mutton, or 
fowls and bacon, with more champagne, «»r beer; then rice 
and curry and ham; afterivards,ga.iae; then pudding, pastry, 
j elly, custard, or blancmange, and more champagne ; then cheese 
and salad, and bread and butter, and a glass of port wine; 
then in many cases, oranges, figs, raisins, and walnuts are 
eaten, tvith two or three glasses of claret or some other wine; 
and this awful repast is finished at last, with a cup of strong 
coffee and cigars. 

Now, in the name of reason and common sense, how can a 
man preserve his health, under such a system.? A man with 
a sound and vigorous constitution, may long resist its bane- 
ful consequences; but for one who escapes unscathed, ten will 
suffer more or less, in various ways; and some of these will 
fall victims; not so much in consequence of the climate and 
season, as from an unnatural, and absurd mode of living. 

Dr. Abercrombie says, "when we consider the mamier in 
which diet is generally conducted, in regard to the quantity 
and variety of food and drink, instead of being astonished at 
the prevalence of indigestion, the wonder would be, that any 
stomach, having such duties imposed on it, is capable of di- 
gesting at all." Sir Francis Head remarks, that "every malady 
to which the human frame is liable, is, either by high- ways 



12 SHANGHAI HYGIENE. 

or bye ways, connected with the stomach; and I must own, I 
never see a fashionable Physician, mysteriously counting the 
pulse of a plethoric patient, or with a silver spoon on his 
tongue, importantly looking down his red, inflamed gullet; 
but I feel a desire to exclaim, "Why not tell the poor gentle- 
man at once; Sir you have eaten too much, you have drunk 
too much, and you have not taken exercise enough". 

Dr. Copland says, "It is superfluous to remark, that second 
courses, served up to gratify the pride of the host, overcome 
the stomach, paralyse digestion, and occasion acute attacks 
of indigestion. Pastry, puddings, rich cakes, and articles 
containing fat, or oily matter, are the most indigestible 
of all kinds of food." Much mischief arises also from the 
food not being properly masticated. Food imperfectly mas- 
ticated, when received into the stomach, is not in a condition 
to undergo, within due time, the changes to be effected by the 
gastric juice. The food itself thus becomes a source of serious 
irritation; uneasy sensations, often amounting to pain are in- 
duced, fetid gases* are also formed and extricated. In many 
cases, partially digested substances, not only produce unea- 
siness and pain, but the stomach is at last compelled to eject 
its contents by vomiting; while in other cases, particles of 
undigested food, pass from the stomach into the duodenum, 
and thus induce, what is called, a bihous attack. The mucous 
coat of the bowel is irritated, and this irritation extends 
along the biliary ducts, inducing redundent secretion of bile, 
and bilious diarrhcea, frequently accompanied with vomiting; 
thus in hot weather, simulating all the symptoms of English 
cholera; which, when a reaction of the biliary organs takes 
place, assumes the appearance of Asiatic cholera. Obstinate 
dian-hcea, and dysentery, are often produced also by undiges- 
ted particles, keeping up a continual irritation of the mucous 
membrane of the bowels; thus, "food may not only be the 
source of dyspepsia", and other diseases, "from defective mas- 
tication, but also from its indigestible quality, from its redun- 
dance, from its being too frequently taken, and from over 
dilution of the gastric juice by an excess of the fluids drank." 
In his work, "On the digestive organs," Cooke says, "the want 
of due relation between the digestive organs, and the sub- 
stances exposed to their action, is not always a disease, for, 



SHANGlLVI HYGIKNE. 13 

if the healthiest stomach be overloaded, or, if the food be of 
an improper quality, dyspeptic symptoms necessarily arise. 
The process of assimilation is extremely complicated, the 
impediments to its completion may arise at any stage. 

They might be found in imperfect mastication, in the con- 
version into chyme in the stomach, or into chyle in the 
intestines, or in any other organs, which eifect the alteration 
the aliment undergoes." Again he says, "It will be found, 
in the management of dyspeptic cases, that a mere reduc- 
tion in the quantity of food, or a change in its quality, 
will remove every unpleasant symptom." I need scarcely 
say, that the truth of these remarks may be verified by 
every day experience and observation in England; but in 
Shanghai, and other parts of the East, to overload the stomach, 
irritate the bowels, or derange the functions of the liver dur- 
ing very hot weather, is to induce serious, sometimes danger- 
ous disease. That which produces uneasiness, indigestion, 
or slight inconvenience in England, will in* Shanghai, during 
the summer and autumn months, induce diari'hoea or dysentery, 
requiring not only careful medical treatment. — (treatment very 
different, I may remark, from that which these diseases require 
in Europe) ; but also change of air, or a more bracing climate 
for perfect recovery. 

Why should a meal in Shanghai be so different from one 
in England.? Why should a man partake of a greater 
quantity of viands at once here, than he used to do at home? 
Why should our palates be pampered by a gi-eater variety 
of food, in the East, than in the West.^* The stomach 
can not digest more, on the contrary, during the warm 
weather, Nature ever a kind and watchful mother, places as 
it were, her fingers on the wheels of the digestive organs, and 
thus prevents them from turning so fast as to oppress the' 
system and induce fever, apoplexy, and other evUs. The late 
Mr. Abernethy, so famed for his knowledge and treatment of 
diseases of the digestive organs, says, "there can be no advan- 
tage in putting more food into the stomach, than it is 
competent to digest, for the surplus can never afford nourish- 
ment to the body; on the contrary, it will be productive of 
various evils. Man in civilized life having food always at 
command, and finding gratification from its taste, and a 



14 SHANGHAI HYGIENE. 

temporary hilarity and energy result from the excitement of 
his stomach, which he can at pleasure produce, eats and 
drinks an enormous deal more than is necessary for his wants 
or welfare; — he fills his stomach and bowels with food which 
actually putrifies in these organs. He also fills his bloodves- 
sels till he oppresses them, and induces disease in them as 
well as in the heart". During Summer and Autumn here, 
the powers of the stomach and digestive organs are weak, 
and therefore it is a most injurious and dangerous practice 
to oppress them with too much, or too great variety of food; 
such practice is sure to result in mischief of some sort, and 
the most common result in Shanghai is diarrhoea; and I am 
strongly inclined to blame errors in diet fully as much, if 
not more, for producing these and other diseases at that season, 
than the Shanghai climate. 

Instead of describing the phenomena resulting from such 
a mode of hving. I shall quote here a true description of it 
by Dr. James Johnson in his work on Tropical Climate. P. 502. 

The phenomena which supervene on the introduction of 
too large a quantity of food and drink into the stomach, have 
been sometimes confounded with the symptoms of indigestion, 
to which indeed they bear considerable resemblance. Thus, 
a man in perfect health, and with an excellent appetite, is 
allured by a variety of dishes, agreeable company, provocative 
liquors, and pressing invitations, to take food more in accord- 
ance with the relish of appetite than the power of digestion. 
No inconvenience occurs for an hour or two ; but then the 
food appears to, and actually does, swell in the stomach, 
occasioning a sense of distention there, not quite so pleasant 
as the sensations attendant on the various changes of dishes, 
and bumpers of wine or other drink. He unbuttons his 
waistcoat, to give more room to the labouring organ underneath ; 
but that only afibrds temporary relief There is a struggle 
in the stomach between the vital and the chemical laws, and 
eructations of air or acid proclaim the ascendency of the 
latter. The nerves of the stomach are irritated by new and 
injurious compounds or extrications, and the digestive power 
is still farther weakened. The food, instead of being changed 
into bland and healthy chyme in a couple or three hours, 
and thus passed into the duodenum, is retained for many 



SHANGHAI HYGIENE. 13 

hours in the stomach, occcasioning a train of the most 
uneasy sensations, which I need not describe, but which amply. 
punish the transgressor of the laws of nature and temperance. 

Instead of sound sleep, the Gourmand experiences much 
restlessness, and what is ca^B^ fidgets, through the ni^ht — 
or, if he sleeps, alarms his neighbours with the stifled groans' 
of the night-mare. In the morning, we perceive some of 
those sympathetic effects on other parts of the system, which 
at a later period of the career of intemperance, play a more 
important part in the drama. The head aches the intellect 
is not clear or energetic — the eyes are muddy — the nerves 
are unstrung — the tongue is furred, there is more inclination 
for drink than food, the urinary secretion is turbid, or high- 
coloured — and the bowels very frequently disordered, in 
consequence of the irritating materials which have passed into 
the intestinal canal imperfectly digested. 

■This can hardly be called a fit of indigestion, though even 
here, we find many of the leading phenomena which afterwards 
harass the individual without such provocation. It is a fit 
of repletion, or intemperance strictly speaking, and repletion 
seldom fails, in the end, to induce that morbid sensibility or 
iiTitabiUty of the stomach and bowels, which forms the 
characteristic feature of indigestion. 

I have called the above Sifit of repletion or intemperance, 
and, of course, it is rather an extreme, case, though by no 
means very uncommon. 

Nine-tenths of civilized society commit more or less of 
this intemperance every day. The over-distention and the 
inordinate daily stimulation weaken the powers of the 
stomach, in the end, according to a law universally acknow- 
ledged in physiology. Any organ which is over exerted in 
its function, is sooner or later, weakened — nay, the remark 
applies to the whole machine. 

Nothing is more common than to see originally good 
constitutions, broken up prematurely by inordinate labour 
whether of body or of mind. The debility thus induced, 
whether of a part or the whole machine, is invariably accom- 
panied by irritability. The former has been recognised in 
all stages as the parent of the latter. In this way a morbid 
SENSIBILITY maybecome established in the digestive organs; 



16 SHANGHAI HYGIK.VE, 

but it does not require a sumptuous table, and a variety of 
wines to induce the above mentioned phenomena. In every 
class of society down to the very lowest, the quality or 
quantity of food and drink is perpetually offending, more or 
less, the n'erves of the stomach and bowels, and thus produc- 
ing the same phenomena as amongthe rich, though modified by 
their habits of life. If we do not find among the lower 
classes the same amount of hypochondriacal and nervous 
affections, we observe a still greater proportion of purely 
corporeal maladies, as organic disease of the stomach, lungs, 
heart, liver, and other parts, occasioning a far greater range 
of mortality than in the upper classes. Besides, the numerous 
other causes of a moral and physical nature which lead to 
this condition of the digestive organs, are found operating 
among all classes without exception. 

If then in health, we experience any of the foregoing 
symptoms after our principal meal, if we have a sense of 
distention, eructations, disturbed sleep, with subsequent 
languor of body or mind, there was intemperance in our 
repast, if that repast did not amount to two ounces of food, 
or two glasses of wine. 

But confirmed indigestion, is not so much induced by 
this violence habitually offered to the stomach, as by the re- 
action of other organs (whose functions have been disturbed 
sympathetically,) on the organs of digestion. The nervous sys- 
tem and the liver repay vrith interest, after a time, the injuries 
they sustain from the stomach. The gastric fluid, so much 
under the influence of the nerves, becomes impaired, the hepatic 
secretion vitiated — and then the phenomena of morbid 
sensibility and of indigestion, gradually acquire a higher 
degree of intensity, by the additional sources of irritation, 
thus generated, multiplied, and reflected from one organ 
on another. Add to these, the effects of the mind on the body, 
where moral causes are out of the question, and where the 
morale, is solely troubled by the physique. 

Again at P. 657, the same Author writes, referring to life in 
India. "In regard to dinner, Europeans appear of late to 
study convenience rather than health, by defening that 
meal till sunset. This was not the case some forty or fifty 
years ago J and many families- even now dine at a mudi 



SHANGHAI HYGIENE. 



17 



earlier hour, except when tyi-ant custom and ceremony p revent 
them. In truth the modern dinner in India is perfectly super- 
fluous, and too generally hurtful. The tiffin, at one o'clock, 
consisting of light curries, or the like, with a glass or two of 
wine and some fruit, is a natural, a necessary, and a salutary 
repast — But the gorgeous table, — the savoury viands — the 
stimulating wines of the evening feast, prolonged by the 
fascination of social converse, greatly exacerbate the nocturnal 
paroxysm of fever, imposed on us by the hand of nature, and 
break with feverish dreams the hours which should be dedicated 
to repose!" 

I shall place here in a tabular form, the comparative digest- 
tability of different kinds of food, as I believe it will be inte- 
resting to many, and useful tp some. In arriving at the 
different results given here, Dr. Beaumont enjoyed opportu 
nities quite unique. Alexis St Martin, a strong healthy man 
in his employment, accidentally had the upper and anterior 
part of the abdominal waU and stomach, destroyed by a shot, 
and after many months careful treatment, a fistulous opening 
remained, through which, by the aid of a speculum, the pro- 
cess of digestion, through all its stages could be carefully 
noted; different kinds of food could also be introduced through 
the opening, v^ith a thread attached, by which the morsel 
could be withdrawn, examined, and weighed, at any period 
of digestion. 

Table shovptng the Mean Time of Digestion of 

THE DIFFERENT AeTICLES OF DIET. 



Articles of diet. 

Eice ' Boiled 



Sago 

Tapioca 

Barley 

Milk 

Milk 

Gelatine 

Pig's feet soused , 



Mode of 


Time Required 


Preparation 


for Digestion 


Boiled 


h.lm. 


do. 


1 45 


do. 


2 


do. 


2 


Boiled 


2 


Kaw 


2 15 


BoHed 


2 30 


do. 


1 



18 



SHANGHAI HYGIENE. 



Arlicles of diet. 

Tripe soused 

Brains '--y, — 

Venison steak 1 

Spinal marrow 

Turliey domestic 

Do. Do -. 

Turkey wild .. 

Goose 

Pig, Sucking 

Liver, beef's fresh 

Lamb-fresli 

Chicken, full grown _ . . 

Eggs fresh 

Do. Do. 

Do. Do 

Do. Do 

Do. Do 

Do. whipped 

Custard 

Codfish, cured, dry 

Trout, Salmon, fresh _. 
Do. Do.-.. 

Bass, striped, fresh 

Flounder Do 

Catfish, Do 

Salmon, salted 

Oysters fresh 

Do. Do 

Do. Do 

Beef, fresh, lean, rare . 

Do. Do. dry 

Do. steak 

Do. with salt only ._ 
Do. with mustard &c, 

Do.* fresh lean 

Do. old, hard, salted. 

Pork steak 

Pork fat, and lean 

Do. recently salted .. 



Mode of Prep. 


Time. 


do. 


h.lm. 


do. 


1 45 


Broiled 


1 35 


Boiled 


2 40 


Roasted 


2 30 


Boiled 


2 25 


Roasted 


2 18 


do. 


2 30 


do. 


2 30 


Broiled 


2 


do. 


2 30 


Fricassee 


2 45 


Hard boiled 


3 30 


Soft boiled 


3 


Fried 


3 30 


Roasted 


2 15 


Raw 


2 


do. 


1 30 


Baked 


2 45 


Boiled 


2 


do. 


1 30 


Fried 


1 30 


Broiled 


3 


Fried 


3 30 


do. 


3 30 


Boiled 


4 


Raw 


2 55 


Roasted 


3 15 


Stewed 


3 30 


Roasted 


3 


do. 


3 30 


Broiled 


3 


Boiled 


2 45 


do. 


3 30 


Fried 


4 


Boiled 


4 15 


Broiled 


3 15 


Roasted 


5 15 


Boiled 


4 3C 



SHANGHAI HYGIENE. 



19 



Articles ol diet 

Pork recently salted 

Do. Do. 

Do. Do. 

Do. Do. •. 

Mutton fresh 

Do. Do 

Do. Do 

Veal fresh. 

Do. Do. . .... 

Fowls domestic 

Do. Do 

Ducks Do.- 

Do. wild 

Suet, beef, fresh 

Suet mutton 

Butter 

Cheese, old, strong 

Soup, beef, vegetables & bread. 

Do. marrowbones 

Do beans 

Soup, barley 

Do. mutton 

Green corn and beans 

Chicken soup.. 

Oyster soup 

Hash, meat vegetables 

Sausage fresh 

Heart animal 

Tendon 

Cartilage 

Aponeurosis 

Beans, pod 

wheaten, fresh 

corn 

Do 



Bread 

Do. 
Cake 

Do. sponge 

Dumpling apple 

Apples, sour and hard . 

Do. ' Do. and mellow 



Mode of prep. 


Time. 


Fried 


h.4m.l5 


Broiled 


3 15 


Eaw 


3 


Stewed 


3 


Eoasted 


3 15 


Broiled 


3 


BoHed 


3 


Broiled 


4 


Fried 


4 30 


Boiled 


4 


Boasted 


4 


do. 


4 


do; 


4 30 


Boiled 


5 3 


do. 


4 30 


Melted 


3 30 


Eaw 


3 30 


Boiled 


4 


do. 


4 15 


do. 


3 


Boned 


1 30 


do. 


3 30 


do. 


3 45 


do. 


3 


do. 


3 30 


Warmed 


2 30 


Broiled 


3 20 


Fried 


4 


Boiled 


5 30 


do. 


4 15 


do. 


3 


do. 


2 30 


Baked 


3 30 


do. 


3 15 


do. 


3 


do. 


2 30 


Boiled 


3 


Eaw 


2 50 


do. 


2 



20 



SHANGHAI HYGIENE. 



Mode of Prep. 


Time 


BoUed 


h.lm.30 


do. 


2 30 


do. 


3 15 


do. 


3 45 


do. 


3 30 


do. 


3 30 


Eoasted 


2 30 


Baked 


2 30 


Eaw 


2 30 


do. 


2 


Boiled 


4 30 


St. Martin was not an 



Articles of diet 

Do Sweet Do. 

Parsnips 

Carrot orange 

Beet 

Turnips flat 

Potatoes Irish 

Do. Do. 

Do. Do. 

Cabbage head 

Do. with vinegar 

Do. Do 

It must be remenibered, that 
invalid when these experiments were made; but a strong 
healthy man accustomed to out door exercise, in a clear bracing 
atmosphere. His digestion moreover must have been excellent, 
much better than that of most people in the East; for we are 
told, "Exper. 42. April, 7th. 8. A.M. St. Martin breakfasted 
on three hard boiled eggs, pancakes and coffee. At half past 
eight o'clock. Dr. Beaumont examined the stomach and found 
a heterogeneous mixture of the several articles, slightly diges- 
ted. At i past 10, no part of the breakfast remained on the 
stomach. Exp. 43. At 11 o'clock the same day, he ate two 
roasted eggs and three ripe apples. In half an hour they 
were in an incipient state of digestion ; aud at a i past 12 no 
vestige of them remained. Exp. 44, At 2 o'clock p. m. same 
day, he dined on roasted pig and vegetables. At 3 o'clock they 
were half chymified, and at half past 4, nothing remained but 
a very little gastric juice. Exp. 46, April 9th at 3 o'clock 
p.m. he dined on boiled dried cod fish, potatoes, parsnips, 
bread, and drawn butter; at half past 3 o'clock, examined, 
and took out a portion about half digested, the potatoes least 
so. The fish was broken down into small filaments; the 
bread and parsnips were not to be distinguished. At 4 o'clock, 
examined another portion, very few particles of fish remained 
entire; some of the potatoes were distinctly to be seen. At 
half past 4 o'clock, took out and examined another portion; 
all completely chymified. At 5 o'clock stomach empty" (P. 158) 

Spalanzani, Magendie, Grmelin, Tiedemann, Eawitz, and 
Gosse, give very interesting experiments and statistics on 



SIlANliHAl IIYGIKXE. 21 

digestion, and the changes which take place in tlie stomach 
under various circumstances; but most of these writers give 
too minute details either to he interesting or useful to non — 
professional readers. Digestion and chymefication are greatly 
influenced hy the interval which elapsed since the preceeding 
meal, the amount of exercise taken, the keenness of the appe- 
tite, the state of the health and mind; the completeness of 
mastication, the state of rest or exercise after eatino-, and 
various other circumstances; and above all, the quantity 
sioalloweiJ in proportion to the gastric juice secreted. 

The readiness with which the gastric fluid acts on the 
several articles, is in some measure determined by the state 
of division, and the tenderness and moisture of the substance 
presented to it. By minute division of the food, the extent 
of surface with which the digestive fluid can come in contact 
is increased, and its action proportionately accelerated. 
Tender and moist substances offer less resistance to the 
action of the gastric juice than tough, hard, and dry ones do, 
because they may be thoroughly penetrated bj'' it, and thus 
be attacked not only at the surface, but at every part at 
once. The readiness with which a substance is acted upon 
by the gastric fluid, does not however necessarily imply the 
degree of its nutritive property, for a substance may be 
nutritious, yet on account of its toughness or other qualities 
hard to digest; and many soft, easily digested substances 
contain a comparatively small amount of nutriment. But 
for a substance to be nutritive, it must be capable of being 
assimilated into the blood; and to find its way into the 
blood it must if insoluble, be digestible in the gastric fluid, 
or some other secretion in the intestinal canal. There is 
therefore, thus far a necessary connection between the digest- 
ibility of a substance, and its power of afl'ording nourishment. 
I shall close this chapter on food with Abernethy's "Kules 
of Diet," in an abbreviated form. 

"1st. "The food should be of the most nourishing and 
readily digestible kind. 

"2nd. The quantity taken at a meal should not be more 
than it is probable, the stomach will perfectly digest. 
'"3rc?. The meals should be taken at i-egular periods of C 
hours three times a day; and when the stomach can digest 



22 SHANOTTAI IIYUIE-N'E. 

very little food, they may Lc taken four times in twenty 
four hours. 

"^th. Every meal of food should be reduced to minute 
subdivision, and pulpy consistenee by mastication, or other- 
wise; and suffered to remain in the stomach unmixed with 
liquids, in expectation that it will be dissolved by the juices 
of the stomach. 

"5i/i. Drink should be taken four hours after each meal; 
allowing that time for its perfect digestion, and two hours 
for the conveyance of liquids from the stomach, before the 
pulpy food be again received. 

"6</i. The drink then taken should not contain fermentable 
substances. It should be boiled water; which may be fia- 
vo\u-ed with toast, or prevented from producing a qualmish 
state of stomach, by pouring upon it a trivial quantity of 
powdered ginger. 

It is not meant by these rules, to debar persons from taking 
a small tea-cup full of liquid with breakfast, or a glass or 
two of wine with dinner, if it seems to promote the digestion 
of their food — " 

These rules are too stringent to be observed by ordinary 
people; they may however be approximated in spirit if not 
in letter, with advantage by most people. The law of Nature 
is plain and manifest — never to eat unless tve are hungry; 
and never to drink unless we are dry; a rid moreover, to observe 
great moderation in doing both. 

Dkink. 

I am not going to write an essay, to ])r(ive that water is 
the only drink proper for man; as soon might 1 prove that 
"coats of skins" are his only appropriate clothing. Man as a 
reasonable being, must exercise his reason liere as every where 
else, and study his own welfare and resj^onsibility, in the 
sight of God and man. In China, I have seen evil result 
from two extremes, both from an obstinate persistency in 
drinking water, as well as in drinking wine; the latter extreme 
however is much more common and injurious than the 
former. "The great physiological rule," "Sir James Martin 
observes, "for preserving health in hot climates, is to Z:eep the 
hody cool. The coimnon sense of mankind would seem indeed 



RIIAXCHAI HVCilEXE. 23 

to point out the iiropriety of avoiding heating drinks, for the 
same reason that we endeavour instinctively to guard against 
a high external temperatur;'. But the truth is, that, until 
men begin to feel the corporeal ill effects of intemperance, a 
deaf ear is turned to the most impressive lectures against the 
most deplorable of propensities, that which Napoleon declared 
to be the least compatible with greatness. With the feeble 
and irresolute, the magic bowl, which this moment can raise 
its votaries into heroes and demi-gods, will, in a few hours, 
sink them beneath the level of the brute creation. Moralists 
and philosophers have long discanted on this theme, but with 
little success, as few will attempt to prove that water is the 
simple and salutary beverage designed by nature for man; 
seeing that every nation, even the most refined, has practically 
repudiated the doctrine. 

Let the medical profession however do its duty, in faith- 
fully portraying the ill effects of the abuse of drink, in 
tropical climates especially. The trutli is, that as drunken- 
ness leads, in a moral point of view, to every ciime, so, in a 
physical point of view, it promotes the invasion, and retai'ds 
the cure, of every tropical or other disease. 

It m'ay be received as a truth that, during the first two . 
yearsof residence at least, the nearerwe approach toa2:)erfectly 
aqiieotis regimen in drink, so much the better chance have 
we of avoiding sickness; and the more gradually and slowly 
we deviate from this afterwards, so much the more retentive 
shall we bo of that invaluable blessing, health. 

I would caution the newly arrived European against a very 
common, and a very dangerous mistake, namely, the acting 
in matters of diet, and exercise, on the supposition that he 
may with impunity do as the elder residents; for it is conso- 
nant with experience as with theory, that the latter class may 
indulge in the luxuries of the table with infinitely less risk 
than the former. To think and act otherwise is to confound 
all discrimination between very different habits of body which 
the seasoned and unseasoned possess. 

We hear much amongst vulgar habitual topers, of the 
supposed prophylactic influence of spirits and cigars against 
night exposure, malaria, and contagion; but no medical 
<>bserver in any of our numerous colonies, has ever seen 



24 SHANGHAI HYUIENJ';. 

reason to believe in any such delusive doctrine, nor is there 
in reality the smallest foundation for it. All eu'citement is 
folloived by a corresponding depression of the vital fimetions, 
and it is then that the toper is doubly liable to suffer. 

Tliose Europeans says the same Aiithority, whi; avoid 
direct solar exposure, and who are temjjerate in the use of. 
Leer, wine, and spirits, will he iu the enjoyment of healtli 
and vigour, and capable to undergo the greatest fatigues, 
mental and bodily without injury; oire familiar example will 
illustrate this subject. 

We will suppose two gentlemen to be sitting in a room, 
in the East or West Indies, just before the setting in of 
the sea-breeze, both complaining of thirst, their skin hot, 
and the temperature of their bodies 100°, or two degrees 
above the natural standard; one of them, applies to the 
negus, beer, or brandy and water cup, and,, after a draught 
or two brings out a copious perspiration, which soon reduces 
the temperature to 98°. It will not stoj) here, however, nor 
will the gentleman according to the plan proiiosed;foi-, in- 
stead of putting the bulb of the thermometer under his tongue 
to see if the mercury is low enoiigh, feeling his thirst increased 
by the perspiration, he very naturally prefers a glass or two 
more of the same stimulating draught, to support the 
discharge, still, however stopping short of intoxication 
Now, by these means,. the temperature is reduced to 97°, or 
962°, in which state even the slight and otherwise refreshing 
chill of the sea breeze checks more or less the cuticular dis- 
charge,, and paves the way for future maladies. 

Let us now return to the other Gentleman, who pursues 
a different line of conduct. Instead of the more ])alatable 
and stimulating drinks, he takes a draught of jjlain cold 
water. This is hardly swallowed before the temperature of 
the body loses by abstraction alone, one degree at least of its 
heat. But the external surface of the body immediately 
sympathising with the internal surface of the stomach relaxes, 
and a mild i^erspiration breaks out, wliich reduces the temp- 
erature to its natural standard of 98°. Farther, this simul- 
taneous relaxation of the two surfaces, completely removes 
the disagreeable sensation of thirst; and as the simple 
"antediluvian beverage," does not possess, many Circean 



;SirA\GHAI nYGIEN'E. 25 

charms for modern palates, there will not h\ lln' slightest 
danger of its being abused in quantity, nor of the perspiratory 
process being carried beyond its salutary limits. 

Nor need we apprehend its being neglected; since from the 
moment that the skin begins to be constricted, or morbid 
heat to accumulate, the sympathizing stomach and fauces 
will not fail again to warn us, by craving the proper remedy. 

Taken, therefore, as a general rule, the advantages of the 
latter plan are numerous— rthe objections few. It possesses 
all the requisites of the former, in procuring a just and 
equable reduction of temperature, without any danger of 
bringing it below the proper level, or of wasting the strength 
by the profuseness of the discharge. 

During, or subsequent to violent exertion, under a power- 
ful sun, or in any other situation in a tropical climate, when 
profuse perspiration is rapidly cai-rying off the animal heat, 
and especially when. fatigue or eShaustion has taken place, 
or is impending, then cold drink might prove dangerous, on 
the same principle as would cold externally applied. In 
persons who have been for some time in the climate and 
whose digestive organs are enfeebled, some weak wine and 
water, may not be objectionable, but such indulgence is by no 
means necessary in the young and vigorous, and it should be 
reserved for ulterior residence, and more advanced periods of 
life. I may here mention, that during the first Burmese war, 
while serving as surgeon to the Groverner General's body 
guard of cavalry, I found warm tea after the most severe 
marches in the sun, by far the most refreshing beverage. 

The habit of Napoleon under great fatigues was as just 
physiologically, as it evinced the sagacity of that wonderful 
man. Finding that excessive fatigue constricted the skin, 
and produced a sensation of cold, he went into a warm bath, 
and on getting out he took a cup of strong coffee — a senso- 
rial stimulant. He thus became in a few minutes, fit for 
renewed exertions, both mental and physical." 

Keferring to the strong feeling which has long prevailed in. 
India against intemperance amongst all respectable classes, 
Dr. Johnson says, "Happily, what was promotive of our in- 
terest, was preservative of our health, as well as condusivo to 
our happiness ; and the general temperance in. this respect, 



26 SHANGHAI HYGIENE. 

which now characterizes the Anglo-Asiatic circles of society, 
as contrasted with Anglo-West-Indian manners, must utterly 
confound those fine spun theories, which, the votaries of 
porter-cup, sangaree, and other gently stimulating liquids 
have invented about "supporting perspiration," "keeping up 
the tone of the digestive organs," &c. All which experience 
has proved to be not only ideal but pernicious! "On the 
meeting together of a company of this class," (planters), says 
a modern Writer on the West Indies, "they are accustomed 
invariably, to sit and continue swilling strong punch (some- 
times half rum), and smoking cigars till they could neither 
see, nor stand; and he who could swallow the greatest quan- 
tity of this liquid fire, or infuse in it the gi'eatest quantity 
of ardent spirits, was considered the cleverest fellow." — 
Account of Jamaica and its inliabitants p. 189. And again, 
"The inferior orders, in the towns, are by no means exempt 
from the reproach of intemperance; nor are the opulent 
classes, generally speaking, behind hand in this respect. 
Sangaree, arrac-punch, and other potations are pretty freely 
drunJc early in the day, in the taverns,— p. 19 9. 

I can conceive only one plausible argument which the 
transatlantic Brunonian can induce in support of his doctrine, 
after the unwelcome denouement which I have brought for- 
ward respecting oriental customs; namely, that as the range 
of atmospheric heat, in the Wesl Indies is several degrees 
below that of the Bast, it may be necessary to counterbalance 
this deficit of external heat, by the more assiduous applica- 
tion 0^ internal stimulus!" 

Here we have a key which opens to a great extent the 
secret cause of unhealthiness of the West Indian climate, and 
the great mortality among the residents there. Query, 
would not the mortality be great among such a class, with 
such debasing habits anywhere and everywhere.^ To give 
some idea of the injurious, eifects of spirituous liquors on the 
stomach and digestive organs I shall give Dr. Copland's own 
words — ^he says, "Dr. Beaumont found on examining St. 
Martin's stomach, after a free indulgence in ardent spirits for 
several days, the villous surface covered with erythematic and 
aphthous patches, the secretions vitiated, and the gastric juice 
diminished in quantity, viscid and unhealthy, although he 



SHANGHAI HYGIENE. 27 

complained of nothing, not even of impaired ajipetitc. Two 
daj's later when matters were aggravated, the erythematic 
appearance was more extensive, the spots more livid, and 
from the surface of some of them, small drops of grumous 
blood exuded. The aphthous patches were larger and more 
numerous, the mucous covering thicker than usual, and the 
gastric secretions more vitiated. The fluids extracted from 
the organ, were mixed with much thick ropy mucous and 
muco-purulent discharges slightly tinged with blood. Yet 
St. Martin complained only of an uneasy sensation, and a 
tenderness at the pit of the stomach, with vert igo and dim- 
ness of vision on stooping. The tongue was covered with a 
yellowish brown coating and the countenance was somewhat 
sallow. After a few days of low diet with mild diluents, 
the inner surface of the stomach assumed its healthy state, 
the gastric juice became clear and abundant, the secretions 
natural, and the appetite voracious. Dr. Beaumont adds, 
that the free use of ardent spirits, wine, beer, or any intoxi- 
cating liquor, when continued for some days, invariably 
produced these morbid states. Eating voraciously, or to 
excess, and swallowing food imperfectly masticated, or too 
fast, produced the same effects, when repeated frequently in 
close succession. 

He often observed, that when stomachic disorder, with 
febrile symptoms, were present, or when influencfed by violent 
mental emotions, the villous coat of the stomach became red, 
im table, and dry; and that but little gastric juice was 
secreted on the food being taken, digestion being very much 
prolonged. No more wine therefore, nor more of any fer- 
mented liquor should be taken, than may be found sufficient 
to support the strength,, without quickening the circulation. 

Again the same writer says — "The bad effects of the 
ingestion of large quantities of cold water into the stomach 
have been often demonstrated; but the subject has been very 
superficially considered. 

Dr. Beaumont remarked that a gill of water, at the tem- 
perature of 55°, received into St. Martin's stomach when 
empty, reduced the heat of the organ from 99° to 70°, at 
which it stood for a few minutes and then rose very slowly. 
This experiment explains the injurious effects produced 



28 i^UAX(.aiAl JIVC.IKXK. 

upon weak stomachs by cold flnids taken during digestion, 
and the fatal effects of very copious draughts of cold Avater 
whilst the body is fatigued or perspiring; the shock which the 
constitution receives, from having the temperature of the most 
vital and central organ suddenly and remarkably deprcsssd, 
paralysing the other vital movements. 

It having been demonstrated that a temperature of 98°, is 
requisite to healthy digestion, it must. follow that the use of 
ices, and particularly iced creams after dinner, or when 
digestion is proceeding, will be most injurious, A fit of in- 
digestion is often caused by them; and they seldom fail of 
lowering the vital tone of the stomach during the digestive 
process. The moderate use, however, of cold or iced water, 
or water ices when this process is completed, and when there 
is no exhaustion is beneficial, by inducing a salutary re- 
action in the organ. Ices can only be taken slowl}-, and in 
small quantities at a time; hence they produce a much less 
sudden fall of temperature of the stomach than draughts of 
cold fluid," 

Shanghai water is very impure, containing a large quantity 
of organic matter." What are we to drink.!* For 7 or 8 
months of the year, bitter beer is as wholesome a drink as 
we could have, but in June, July, August, and September, 
it is not the best, and during these months is injurious to 
many. On several occasions I have satisfied noyself that in 
many cases it produces diarrhoea. Draught beer is more 
wholesome than the bottled; and many people have excellent 
health by taking a glass of beer at tiffin or dinner all the 
summer; bottled pale ale contains more carbonic acid which 
causes drowsiness and sleep. Dr. Lankester says "it contains 
more alcohol than hock, claret, or moselle wines, and as 
much as Burgundy. Pale ale contains large quantities of 
hops which are said to be tonic, febrifuge, anthelmintic, 
and hypnotic." "Beer" say.s Dr. Pereira, "consists of water, 
alcoliol, lupulite (the bitter principle of hops) volatile oil of 
hops, gum, sugar, gluten, brown extractive, a small portion 

* shanghai water should never be used as drink alone, unless it is both 
filtered and bailed; iflho-ouglily filtered, it may be drunk with wine or a little 
brandy without boilinir; but it contains so much organic matter, it should all be 

boiled. 



SHANGHAI HYGIENE. 29 

of taimic acid, and the phosphates of lime and magnesia 
held in solution by phosphoric and acetic acids. Beer differs 
from wine in several important particulars. Thus, it contains 
a much larger quantity of nutritive matter, and a considerably 
less proportion of alcohol; but it has in addition a peculiar 
bitter and narcotic substance. That its inebriating quality does 
not wholly depend on the alcohol which it contains, is shewn, 
by comparing the quantity of spirit obtained by Mr. Brande 
from brandy, wine, and porter. From his experiments it 
appears, that the same quantity of spirit is contained in the 
following quantities of wine, brandy, and beer 

Port Wine 1.00 

Claret ..1.52 

Champagne 1.82 

Brandy .0.43 

Burton ale 2.58 

London Porter 5.46 

Small Beer 18.16. 

Now, if the intoxicating^ quality of beer, depended on the 
spirit merely, the effects of five and a half pints of London 
Porter, or two and a half pints of Burton ale, should be 
equal only to that of a pint of port wine; whereas its actual 
inebriating power greatly exceeds this. 

That beer is nutritive, and, when used in moderation 
salubrious, can scarcely be doubted. It proves a refreshing 
drink and an agreeable and valuable stimulus and support, 
to those who have to undergo much .bodily fatigue. 

Beer is a heat producing substance, and is not therefore 
the best drink in hot weather, as it will increase the action 
of the liver. Porter is objectionable at all times, but espe- 
cially in the hot season. Dr. Lankester says, "porter is 
miserably drugged, its strength is reduced by water and its 
qualities are brought up again by treacle, liquorice, and salt, 
and various narcotic agents are added to make up for the loss 
of Alcohol. To such a condition has the porter-drinking 
population been brought, that they do not know genuine 
porter when they drink it, and having acquired a taste for its 
wretched substitute, they reject the unadulterated Article." 
Wine. Wine is not essential to the welfare, or health of a 
strong man in Shanghai more tha^i in England. Neverthe- 



30 SHANGHAI HYGIENE. 

less ceteris paribus, I believe a man's health is more 
secure with a moderate quantity of wine in such a climate 
as this. Taken in moderate quantities, (by which I mean 
from 3-to 5 or 6 glasses per day of port or sherry, or from 
half to a whole bottle of French or German wine) it operates 
as a mild stimulant to the vascular and nervous system, it 
promotes the various secretions, diffuses an agreeable feeling 
of warmth over the body, quickens the action of the heart, 
increases muscular force, excites the mental powers, and 
dispels unpleasant thoughts. All wines are more or less 
acid, this is owing to the presence of taitaric, tannic, malic 
and citric acids; while the sparkling, frothing, effervescent 
wines contain carbonic acid gas. Sherry maybe used during 
the whole year in Shanghai, yet in some cases I have known 
it produce diarrhoea. Port is not suitable for hot weather, 
it is slightly astringent and is good in certain cases, but is 
very apt to disagree with, weak stomachs. Madeira is only 
suitable for elderly people and comparative invalids. Cham- 
pagne is safe in hot weather, but is apt to interfere, with 
the healthy powers of digestion; owing also to the amount 
of sugar it contains, it induces thirst; it is exceedingly useful 
in cases of hypochondriasis, and in obstinate vomiting. 
Burgundy is excellent in 'hot weather; it is somewhat astri- 
ngent, and will be found exceedingly refreshing during, or 
after fatigue. Rhine wines are cool and refreshing and prove 
an excellent and agreeable beverage on a hot day. Glaret is 
the best, and perhaps the safest of all wines or alcoholic 
beverages during the summer months here. It is slightly 
astringent, tonic and refrigerent; claret will be found to agree 
with, and prove beneficial in more individual cases than any 
other wine during hot weather; acting on the digestive 
organs as a mild tonic, it both promotes digestion, and 
prevents lassitude, Ardent spirits; Brandy, Rum, Gin, 
and Whiskey, should never be taken unless largely diluted, 
and even then, very sparingly. Weak brandy and water 
occasionally, is a safe drink for old residents in hot weather. 
Soda water and Lemonade, are good, refreshing, grateful 
beverages, when however they are taken in excess they prove 
injurious to the process of digestion, by distending the 
stomach with gaseous air, and by diluting, the o^astric fluid 



SHAXGIIAI HYGIEXK. 31 

with alkaline constituents. I knew a young man who came 
to Shanghai with a fine constitution, and with excellent 
prospects; he used to boast that he drank 18 bottles of 
soda water daily, during the summer, and that he could eat 
all kinds of fruit. This however could not last, and after a 
short iUness he died near the close of his second year.* Tea 
is far too little used, during hot weather. It has a peculiar 
and gently stimulating influence on the nervous system, 
which is not followed by a corresponding depression, as after 
wine or beer. Tea is also slightly astringent. Dr. Copland 
says, "the infusions of black and green tea are gently tonic 
and narcotic, the latter acting more energetically upon the 
cerebro-spinal system than the former; green tea usually 
excites the nervous powers, as coffee increases the activity of 
the cerebral functions. 

But when morbid, vascular, or nervous excitement exists, 
it gener9,lly proves an excellent tonic and sedative, procuring 
sleep, and diminishing both nervous and vascular disorder. 
In cases of asthenic vascular action attended by coma or 
lethargy, I have found it a most valuable restorative of both 
vital and cerebral power." Tea and coffee are not nutritious, 
but their action in the system is closely analagous to that of 
a nutiitive substance, they retard disintegration of the tissues 
of the body; in other words, the body is sustained and sup- 
ported under the use of tea and coffee, as these agents 
prevent the waste of tissue which would, without them, under 
great exertion of body or mind, take place much more 
rapidly; and thus exhaustion would more speedily ensue. 

To shew that the action of tea on the system is more 
potent than is generally supposed, and as we moreover dwell 
in the land of tea, I shall place here in a tabular form, an 
accurate analysis of the composition of a pound of tea, made 
bv Lehmann and published by Baron Liebig. 

oz. grains. 

Water 

Theine 



I 350 
210 



♦ Tonic water is good and wholesome, but care should be taken that it is 
prepared by a respectable House or Company. Sch\yeppe'3 tonic water is best, 
but much is manufactured by speculators in all parts of the world, that will tend 
to any thin^ rather than licallhy lime in the system. 



32 



SHANGHAI HYGIENE. 



Caseine 

Aromatic oil . . 
Grum 

Sugar -. 

Fat 

Tannic acid 

Woody Fibre _ 
Mineral matter 



oz. 


gr. 


2 


175 





52 


2 


385 





211 





280 


4 


. 87 


3 


87 





350. 





47-45 





1.24 





6.84 





3.29 





9.88 





8.72 





2.31 





10.09 





0.71 





3.62 





5.03 





1.09. 


T eve 


ry substance 


system, that these 



Potash. 

Lime 

Magnesia. 

Per-oxide of Iron . 

Phosphoric Acid . 

Sulphuric Acid . 

Silicic Acid 

Carbonic Acid . 

Oxide of Manganese . 

Chloride of Sodium. 

Soda. 

Charcoal and sand. 
Now it will be observed, that nearlj 
mentioned here, acts powerfully on the system, 
salts especially perform important parts in the human body. 
Thus we find iron, lime, potash, chloride of sodium and 
phosphoric acid essential elements for the construction of 
the tissues, and for the performance of the functions of the 
body. Liebig remarks, that "we have in tea a beverage which 
contains the active constituents of the powerful mineral 
springs, and however small the amount of iron may be which 
we daily take in this form, it cannot be destitute of influence 
on the vital process." Theine however is the principal agent 
in the action of tea on the nervous system. It holds the 
same position in tea, as alcohol does in brandy, wine, and 
beer; and as I feel convinced that tea is the best, safest, and 
most wholesome drink we could take here in the hottest 
weather,* I shall quote Dr. Lankester's words; referring to the 



' * I may state, that during my two first years in Shanghai,.! drank nothing 
stronger than tea and coffee. During the hot weather I ha'l two bottles of tea 



SHAKGHAl HYGIENE. 33 

action of Theine. "I have no doubt," he says "in my own 
mind, that the action of Theine on the system is principally 
through the agency of the nerves. If given in sufficient doses 
to animals it kills them. I have given it to frogs, and found 
that half a grain is sufficient to kill a full-grown frog. The 
animal is at first paralysed, and after sometime becomes con- 
vulsed and dies. The death in this case is very similar to 
that which is observed from the action of hydrocyanic acid, 
hemlock, and other sedative poisons. Such poisons do not 
produce sleep or drowsiness at once, and it is only when 
insensibility comes on that any remarkable derangement of 
the functions is observed. 

This action of the theine on the nervous system seems to 
me to account for the influence exerted on the system by tea 
aiid coffee. They exercise primarily a calmative influence, 
produce a sense of repose, which without being depressing 
in the slightest degree, prevents a morbid activity of the 
nervous system. I cannot but think that the craving for tea 
and coffee, which is frequently exhibited by strong men, 
depends on this influence of the theine on the nervous 
system. 

But the action of theine is not altogether dependent on its 
imniediate influence on the nervous system. It has been 
shewn by competent experimenters that it,has the same kind 
of conservative action on the tissues that are found to take 
place with alcohol. It seems that any of those substances 
which exert an influence on the nervous system, whether that 
influence is sedative or stimulant, prevent the destruction of 
tissue." 

Theine, and most of the other ingredients in tea, are soluble 
in hot water, and most of the theine will be extracted by the 
water which is first poured on the tea; if therefore the tea- 
pot is emptied and fresh water added, the second cup will 
contain,neither theine, nor any of the volatile or aromatic oil, 

made in the morning with a little citric acid I used as a drink tlirough the day, 
and found it both reireshin/ and agreeable. 

Dr Lankeiter says, "the Russians add sugar, but either sqeezc in a little 
lemon juice or add a slice of lemon. This I can assure you is no despicable 
addition. When the stomach is already clogged with food, as is the case after 
dinner, when thirst is best allayed by acids^ then the addition of lemyn or its 
juice is most palatable and agreeable." 



34 



SHAl^GHAI HYGIENE. 



which gives to each kind of tea, its own peculiar flavour. A cup 
of ordinary tea contains from hal£;i grain to a grain of theine. 
Oreen and black tea contain precisely the same constituents, 
only green tea contains much more aromatic oil, which seems 
to produce a powerful influence on the nervous system quite 
harmless if taken in moderation,* but if used in excess, its 
effects are very similar to those produced by fox glove or 
digitalis, namely, palpitation of the heart, great anxiety, 
nervousness, and sleeplessness, unless given in poisonous 
doses. 

I need not say much on coffee as its action on the system 
is very similar to that of tea, I shall however give a table of 
analysis by Payen; one pound of unroasted coffee contains. 

Water 

Sugar 

Fat 

Caseine 

Caffeine or Theine 

Aromatic oil 

Caffeic acid with potash 

Gum- _ 

Woody fibre 

Saline matter , 

"The caffeine of the coffee says Dr. Lankester, is identi- 
cal with the theine of the tea, I need not therefore dwell on 
its properties. It is, however, an interesting fact worthy of 
a moment's consideration, that the coffee plant should produce 
a compound which closely resembles the quinine and chincho- 
nine of other members of the chinchona family. If we were 
in doubt as to the effects of caffeine, on the system, we might 
appeal to the known action of quinine, as illustrative of its 
action. If there is one fact better proved than another in 
the history of medicine, it is, that quinine has the power of 
arresting intermittent fever or ague. This is so well known 
that no tyro in medicine would think of treating a case of 

* During my two last years at college, I used green tea and strong coffee 
freely, studying every night till '2-and 3 o'clock a.m. This wilh two light 
meals per day, one at half pa&t 8 i.M., and the other about 6 p.m., I enjoyed 
excellent health, and could do almost any amount of work. 



)Z. 

1 


gr. 
407 


1 


17 


1 


402 


2 


35 





122 





1- 





280 


1 


192 


5 


262 


1 


31 



SHANGHAI HYGIENE. 35 

ague without quinine. Now it so happens that there are 
certain cases of ague which will not yield to quinine, and 
these cases have been known to yield to theine, the composi- 
of these substances is as follows. 

Water, Carbon, Hydrogen, Nitrogen, Oxygen. 

Theine 2- 1 6 10 4 4 

Quinine — ;-3 20 12 1 ^2 

We can hardly doubt that each of them is capable of 
acting on the nervous system, and that what is true of the 
action of quinine is also of theine or caffeine. 

Let more tea and coffee then be used in hot weather, and 
let the stronger wines and beer be used very sparingly, and let 
French and German wines take their place. 

Exercise. 

During the last three and the first five months of the year 
in Shanghai, the more exercise taken the better. 

By exercise, I do not mean a stroll along the Bund, or a 
walk out to the Kace-course. On a cold raw damp winter 
day, it would be better to keep in the house than to do this, 
as one only gets chilled. In order to be beneficial, exercise 
must be taken so as to stimulate all the bodily functions, 
the circulatioQ should be quickened, respiration should be 
accelerated, more or less perspiration shoi^d be induced, and 
a healthy glow shouldbe communicated to the whole system. 
There is no exercise so good as walking, as thereby every or- 
gan or function is more or less in action, all the muscles are 
exercised and strengthened, especially those of the back and 
lower extremities. Walking however without an object in 
view beyond that of exercise is tiring and monotonous, and 
besides, it is often impossible here on account of bad roads. 
It is much to be regretted that there is no cricket ground in 
Shanghai, as it would tend much to healthy exercise, 
morning or evening, or both. Surely a suitable field could be 
obtained within easy access of the settlement. It should be 
large enough to allow several games to be carried on at once. 
Within a mile or two of the "Mng-po Joss House," the ex- 
pense would not be great and it would be a great accession 
to pleasure abdhealthyexercise for all classes. Kiding on horse 
back is also very good and healthy exercise; but driving in a 



36 SHANGHAI HYGIENE. 

carriage or riding in a chair is only suitable for invalids, 
being far too passive for healthy people except in hot weather, 
when all active exercise should "I'O modified or suspended. 
All exercise tends to increase tho temperature of the body; 
but in hot weather this is not desirable, no more therefore 
should be taken than what is essential in the performance 
of our daily duties, except early in the morning, or after six 
o'clock in the evening, when a ride on horseback, a short 
walk, a drive, or a pull on the river may be beneficial. Sir 
James Martin says, "exercise is one of the luxuries of a nor- 
thern climate to which we must, in a great measm-a, bid 
adieu between the tropics. The principal object and effect 
of exercise in the former situation appear to consist in keep- 
ing up a just balance in the circulation, in supporting and 
maintaining the functions of the skin, and promoting the 
various secretions. But the perspiration, biliary, and other 
secretions being already in excess in equatorial regions, a per- 
severance incur customary European exercise, would prove 
highly injurious, and it oftep does so, by promoting and aggra- 
vating the ill effects of an unnatural climate. As such excess 
very soon leads to debility, and to diminishing action in the 
functions alluded to, and to a corresponding inequilibrium 
of the blood, so it is necessary to counteract t];i3se by such 
active or passive exercise as the climate will admit, B.i par- 
ticular periods of the day or year; a discrimination 
imperiously demanded if we mean to preserve health. When 
the sun is near the meridian for several hours of the day on 
the plains of India, not a leaf is seen to move, every animated 
being retreats under cover, and even the "Adjutant," or 
gigantic crane of Bengal, soars out of reach of the earth's 
reflected heat, and either perches on the highest pinacles of 
lofty buildings, or hovers in the upper regions of the air, a 
scarcely discernible speck. 

At this time the native retires instinctively to the inner- 
most apartment of his humble shed where both light and 
heat are excluded. There he sits quietly in the midst of his 
family, regaling himself with cold water or sherbert, while a 
gentle perspiration flows from the skin and contributes 
naturally and powerfully to his refrigeration. 
■-After this example of the salutary habits of all classes of 



8HANGHAI HYGIENE. 37 

natives of India, it is hardly necessary to urge the injurious- 
ness of every kind of active exercise to Europeans under 
tropical heats, and especially during the heats of the day, 
yet hundreds perish annually from this very cause. 

The swing might perhaps be rendered useful in the hot 
and rainy season in the East Indies. In chronic disorders of 
the viscera, it could hardly fail to be grateful and salutary, 
by its tendency to determine to the surface, and relax the 
subcutaneous vessels, which are generally torpid in those 
diseases. It might he practised in the early mornings and 
evenings within doors, whenever the weather or other circum- 
stances do not admit of exercise in the open air." ■ 

Clothing. 

The cardinal rule to be observed, with regard to the chan- 
geable temperature of Shanghai, is, always to put on warm 
clothing as soon as the afternoons and evenings begin to be cool 
at the close of summer; and not to put on light summer 
clothing, until the warm weather has fairly set in. I feel 
convinced, that more diarrhoea, dysentery, and ague are in- 
duced by insufficient clothing during the Autumn, than by 
any other cause: and this not merely during the day and 
evening, but also, and more especially during the nights, 
which about the middle of September become very cold, and 
these chilly nights should always be anticipated, by one or two 
more blankets being put on the bed. I have traced more di- 
seases of the bowels, and more functional derangement of the 
different organs to the neglect of this precaution, than to any 
other cause at that season. The change of temperature is 
usually sudden; on the night of the 10th September 1860, it 
fell 15° below wtiat it had been for three months previously, 
and during the night of the 6th September 1861, it fell 18° 
below what it had been since the beginning of June. The 
consequence was a large number of cases of bowel complaints, 
both among natives and foreigners, also several cases of 
cholera and jaundice. At that season it is no uncommon 
thing to wake up at two or three o'clock cold and chilled, 
and with pain in the bowels, the precursors of diarrhoea, dy- 
sentery, or cholera, and if one has to get out of bed at that 
time, matters are made worse. A safe precaution whick 



38 SHANGHAI HYGIENE. 

should never be forgotten, is, to have an extra blanket over 
the feet, which when cold is felt can readily be pulled over 
the body. The great object is to get into a slight perspira- 
tion, as by this means all the fluids, which by the cold, had 
been driven upon the inner organs and bowels, causing 
congestion and griping pains, are again attracted to the 
surface of the body, and instead of passing off by the bowels, 
escape by the skin; thus a reaction takes place, and the 
balance of the circulation is again restored, and disease is 
prevented. I am fully convinced that in my own case, I have 
frequently prevented an attack of diarrhoea by this simple 
means, a means within the reach of all, and which I am 
persuaded, will, if observed, prove an effectual antidote to 
one of the most prolific sources of disease of the bowels, 
during the Autumn in China. Beds with cane bottoms are 
best during the hot weather, the mattress should be put 
away, and a Hanket spread over the cane work; this will be 
found very much more cool than sleeping on a mattress, and 
instead of rising in the morning, bathed in perspiration and 
feeling exhausted, we wake up comparatively cool and 
refreshed. A blanket ought also to be kept on the bowels, 
even during the hottest weather. The extremities and chest 
may be exposed, but it is never safe to sleep without having 
the bowels well covered. 

These remarks are simple, and may appear to some insig- 
nificant; but they are made after mucih careful observation, 
and considerable practical knowledge and experience. I 
might say much more on this important subject, but prefer 
giving the mature opinions of Dr. Johnson and Sir J . Martin. 
"When Europeans enter the tropics they must bid adieu to 
the luxury of linen — if what is uncomfortable, and indeed 
unsafe in these climates, can be called a luxury. The natives 
of the country from the lowest to the highest, wear none but 
cotton clothes, and those of them who can afford luxuries, 
wear them in the largest quantities. The ample turban, 
and khummerbund meet our eye at every step ; the former to 
defend the head from the direct rays of a powerful sun — the 
latter for the purpose of preserving the important viscera of 
the abdomen from the deleterious impressions of cold. The 
khummerbund is certainly a most valuable part of the dress, 



SHANGHAI HYGIENE. 39 

and one that is extensively imitated throughout India, loy 
Europeans, in the form of a cotton or flannel waist hand, 
worn generally next the skin. 

The cotton dress from its slowness of conducting heat is 
admirably adapted for the tropics. It must he recollected 
that the temperature of the atmosphere, sub dio, in the hot 
seasons, exceeds that of the blood by many degrees, and even 
in the shade it too often equals, or rises above the heat of 
the body's surface, which is always during health, some 
degrees below 97°. 

Here then we have a covering which is cooler than Hnen, 
inasmuch as it conducts more slowly the excess of extarnal 
heat to our bodies; but this though a great advantage, 
is not the only one. 

When a vicissitude takes place, and the atmospheric 
temperature sinks suddenly, far below that of the body, the 
cotton covering, faithful to its trust, abstracts more slowly 
the heat /rom it, and thus preserves to the wearer a more 
and more steady equilibrium. To all these advantages must 
be added the facility with which cotton absorbs perspiration. 
While Knen so circumstanced would feel wet and cold, under 
a breeze, and even occasion a shiver, the cotton dress as 
stated, would maintain an equable warmth. 

That woollen and cotton dresses should be warmer than 
linen in low temperatures will be readily granted; but that 
they should be cooler in high temperatures, will, perhaps be 
doubted. But let two beds be placed in the same room, 
during the day when the thermometer stands at 90°; and 
let one be covered with a pair of blankets, the other with a 
pair of linen sheets. On removing both coverings in the 
evening, the bed on which were placed the blankets will be 
found cool, the other warm; The linen transmitted the heat 
of the surrounding air to all the parts beneath it, while the 
woollen covering as a non-conductor, prevented and obstruct- 
ed the transmission of heat from without.* 

* "This experiment not only provres the position, but furnishes us with a grate- 
ful and salutary luxury free of trouble or expense; — The musical ladies of India 
are noi unacquainted with this secret, since they take care to keep their pianos 
Well covered with blankets in the hot seasons, to defend them fcom the heat and pre- 
vent their warping." 



40 SHANGHAI HYGIENE. 

From this view of the subject, flannel might be supposed 
superior to cotton, and indeed at certain seasons, or in par- 
ticular places where the mercury often takes a wide range in 
a very short time, the former is a safer covering than the 
latter, and is adopted by many experienced and seasoned 
Europeans. But in general, flannel is inconvenient for three 
reasons. First, it is too heavy; an insuperable objection. 
Secondly, where the temperature of the air ranges pretty 
steadily a little below that of the skin, the flannel is much 
too slow a conductor of heat /rom the body. Thirdly, the 
spiculsB of flannel prove too irritating, and increase the action 
of tho perspiratory vessels on the surface of the body, where 
our great object is to moderate that process. From the 
second and thiid objections indeed, even cotton or calico is 
not quite free, unless of a fine fabric, when its good qualities 
far counterbalance any inconvenience in the above respects. 

The great object of tropical prophylactics being, to moder- 
ate WITHOUT CHECKING THE CUTICULAE DISCHAEGE; I WOuld 

here enter a caution against a too frequent changing of body 
linen, a habit confined to newly arrived Europeans princi- 
pally. To change morning and evening is enough for all and 
every purpose, even in the hot, and rainy seasons; and to 
change oftener is simply injurious. The property which/re- 
quent change of linen has, in exciting the cuticular secretion, 
and the effects resulting from thg, sympathy of the skin with 
the stomach, liver and lungs, may account in a great measure 
for the superior health which accompanies cleanliness in our 
own climate; and on the contrary for many of the diseases 
of the indigent and slovenly, which are so frequently 
connected with, or dependent on, irregularity or suppret^sion 
of the cuticular discharge. But though this is true, by the 
injudicious, nay injurious habit of too frequent change of 
linen in a tropical climate, the fluids on the surface of the 
body, already in excess, are thus powerfully solicited, and 
the action of the perspiratory vessels, with all their associa- 
tions, morbidly increased, instead of being restrained. 

It is laughable, or rather pitiable enough to behold a set 
of griffinisii sticklers for decorum, for some time after each 
fresh importation from Europe, whom no persuasions can 
induce to cast oiF their exuvies, even in the most affable 



8HANGHAI HYGflENK, 41. 

company, pinioned in their stiff habiliments, while the 
streams of perspiration that issue from every pore, and ooze 
through various angles of their dress, might almost induce us 
to fear that they were on the point of realizing Hamlet's 
wish; and that in good earnest, their 

"Solid flesh would melt — T^aw and resolve itself into 
a dew." r^ 

Attention to the above suhJOTH, is perhaps the most essen- 
tial for the preservation of health in China; there are however' 
others too important to be neglected or forgotten, I hope 
to be excused therefore, if I mention two or three matters 
which I think require attention, although from the limits of 
this work, it will be observed that I can do little more than 
touch slightly on each subject. 

Bathing 

Says Dr. Johnson, "is one of the most powerful engines 
we possess for counteracting the destructive influence of a 
cold climate, because it connects the most grateful sensations, 
with the most salutary effects, it is indeed both utile et 
dulce." Dr. Moseley says, "cold bathing is death with intemper- 
ance, and dangerous when there is any fault with the viscera." 
Many intemperate men however could tell Dr. M. a different 
story; for example, the famous Mr. Weeks of Jamaica, al- 
ways went to sleep in cold water when intoxicated, and many 
a drunken sailor is instantly made sober by tumbling over 
board; Sir James Martin speaks truly when he says, "The 
cold bath is death, not during intemperance, but in the 
collapse which follows a debauch, or indeed any other great 
fatigue of mind or body. To the European resident in 
tropical climates, whose constitution is sound and whose 
habits are temperate, no more efficient means exists, of 
obviating the most unpleasant effects even ofthe cold season; 
for he who reacts well under the cold bath will not be trou- 
bled with dry skin, and sense of internal fulness. To persons 
of ordinary health, but who are not robust, the cold bath will 
be found tonic and agreeable, from the beginning of March, in 
India generally, to the end of September. The temperature 
ranges high in these months, and the determination to the 
surface is such as to ensure a sufficient reaction. It i« a 



42 SHANGHAI HYGIENE. 

common error to suppose, tliat before using the cold bath we 
must get cooled first, while the very opposite rule is the 
correct one. To the delicate indeed, immersion in a warm 
bath for a few minutes is an excellent preliminary, followed 
at once by the affusion of three or four vessels of cold water. 
A glow over the whole surfaqe of the body will immediately 
follow. This is a safe and ascellent mode of bathing to all 
who shrink from, or feel dowtful of salutary reaction from 
the use of cold water. 

We hear warm and cold bathing recommended without 
reference to the state of health, to the season, or to regular- 
ity of habit, although these circumstances should form es- 
sential preliminaries to the choice. It may be concluded for 
certain , that, to persons who have suffered from tropical 
disease, or who are affected with visceral congestions, or with 
visceral enlargements, especially, the results of fevers or 
dysenteries, the warm bath is the only safe one at all seasons. 
The same rule applies to the dissipated, and to such as are 
in the habit of keeping late hours. In such persons the 
balance of circulation is already disturbed, and the effect of 
cold water is to throw the blood with force on organs already 
irritated by irregular courses of life, the abdominal viscera 
especially." 

Early in the morning is the best time for the cold bath, on 
getting out of bed; the warm bath is best at night. A cold 
bath before dinner in hot weather is sometimes refreshing,' 
but once a day is sufficient. The temperature of the 

Cold bath is from 50°. to 70° 

Tepid 80°. to 90° 

Warm- 90°. to 98° 

Hot 98°. to 120 

Bathing is a powerful therapeutic agent and I feel con- 
vinced it does not occupy such a position as it is entitled to, 
in treating diseases in China. We lack those facilities, which 
are essential to the proper application of water as a remedial 
agent, in treating diseases here; and one great boon connected 
with an hospit al for Foreigners here would be, that different . 
kinds of baths for treating various diseases could be esta- 
blished. 



SHANGHAI HIGIENE. 43 

In all kinds of bowel complaint, chronic or acute diarrhoea 
and dysentery, cholera and fevers, bathing, properly timed 
and regulated, is invaluable. I need scarcely speak here of 
the value of the Turkish bath as a remedial agent, or how 
much such a bath is needed in Shanghai. Some excellent 
letters on its merits appeared in the North Ghina Herald 
last Autumn. Judiciously used in treating disease, its im- 
portance can scarcely be overrated, but like every other 
powerful remedy, caution, and great discrimination are requi- 
site in its application, especially when the patient is delicate, 
or much reduced by disease. 

I shall give the opinion of two or three medical men, who 
are practically acquainted with its merits ; and I would 
observe that these men are neither hydropathists, nor specia- 
lists, but are ready to employ every means to preserve and 
restore health; and although I am not prepared to go quite 
so far as some of them, regarding its merits yet it should 
occupy a pYominent place, both in prevention and cure. 
Dr. Le Gay Brereton says "If you want to save Doctor's bills, 
take the Bath. I do not mean to say that it altogether 
supersedes medicine; every poison has its use, and I am well 
aware that for local effects, hydropathic appliances are often 
necessary; but I do say that in a vast majority of, if not in 
all, blood diseases, the bath is more speedy, more certain, 
and far more agreeable than any other treatment of disease, 
above all this, it is the preserver ot health; it heightens 
every personal charm, the complexion especially becomes 
clearer under its use, the eyes brighter, and the person posi- 
tively fragrant. Homer does not exaggerate when he describes 
Achilles, on issuing from the bath, as looking taUer and 
fairer, and nearer the gods." 

The doctor allows his enthusiasm to out run his discretion 
a little when he says, "When the population of ancient 
Eome was said to b^ five millions(.?) there were Baths in 
abundance but no Hospitals; and it is recorded that during 
a period of 500 years, there was no physician in that vast 
city." 

Dr. Tucker says in reference to the Turkish bath," Small- 
pox came in as the thermse of the ancient Komans went out 
of general use. Curious, small-pox scarlatina, and cholera, 



44 SHANGHAI HYGIENE. 

wMch now form tlie triple scourge of mankind, were un- 
known to the ancient Greeks and Komans, as if they were 
inflicted as a punishment, for our singular neglect of the 
physical virtue of personal purification of the skin in latter ages. 
The skin, the safety-valve for all the inner vital organs — 
their sewerage requires to be regularly used. It was the only 
organ consigned specially to man's own care, and placed 
within his observation, and, notwithstanding, it is the one 
most neglected. 

I believe we are all more or less cut off twenty years 
before the natural time to which we might live; if we only 
observed the laws of Nature, and the precept of personal 
purification as strictly as the ancients did. We work the 
bowels which are the negative pole of our electro-chemical 
battery, and neglect the skin, the positive pole, although it 
is a more important eliminator of morbid matters from the 
blood. Only one in a thousand reaches 70 years, although 
100 years is the full term of natural life." 

Dr T. ought to give us his authority for saying that man's 
natural time on earth is 100 years, perhaps he thought of 
FlourensandViscomte Lespasse, the head of the modern sect 
of Centenaires. Unfortunately for the doctor there is a very , 
old Book, considered a good authority, and it declares man's ^ 
natural period of life to be, only three score years and ten, and 
that it is an exception to attain even four score years. Nev- 
ertheless, remembering Dr. T's warm Celtic constitution, and 
that he advocates a good cause, we overlook his errors. — He 
thus urges the claims of the Turkish bath. "Surely the living 
temple of this divine light deserves to be kept clean, to be 
purified. Man, the living likeness of his Almighty Maker, 
the epitome of the universe, the beauty of this world, the 
living testimony of two worlds — 'of one within the other, the 
noblest study of mankind; man should keep his house in 
order, even though it occupied two hojirs once or twice a 
week. I trust the day is not distant, when the sign of a lady, 
and of a gentleman will be that they take the weekly thermo- 
electrical bath of Nature, and that statues may perpetuate 
the memories of the sovereign, the prince, the peer, the physi- 
cian, or the patriot to whom we shall be most indebted'for 
recalling these ancient Roman Temples of Health, from the 



SHANGHAI HYGIENE. 45 

tombs of oblivion, and consigning them to the cradles of the 
rising generation, a? the most important innstitutions for 
promoting public health and personal reform. This bath is 
social as well as sanitary: it destroys the craving for strong 
drinks. It is a Temple of Temperance. The illustrious 
Bacon lamented the loss of these baths to European nations. 
Would that our glorious Queen Victoria would institute a 
fourth class vt this ancient order of the Bath, to be conferred 
upon those who would patronize, support, and frequent, 
these Temples of Health. What higher honour could a lady 
or gentleman desire, that to be permitted to wear the crimson 
ribbon of this Order, with its Motto— Tria juncta in uno, 
as the badge of Temperance, Purity, and Pleasure." 

Dr. Cummins of Cork says, "The Turkish bath is power- 
ful in disease, and for that very reason, the Turkish bath 
should be regularly prescribed, and its effects watched by 
the Physician". 

The London Medical Times and Gazette says, "There 
can we believe, be no two o^iinions concerning its great utili- 
ty. Its uses and value are plain, and simply enough 
explained. It acts enei'getically on the skin. The importance 
of the cutaneous function is manifest enough. If, therefore, 
it promotes and assists the skin in the performance of its 
function, it becomes evidently an instrument of great service 
to the body in health, and, when wisely applied, also to the 
body in its pathological conditions." 

Let us hope then that we shall soon have such an' acquisi- 
tion added to the numerous improvements of our thriving 
community; and that the enterprizing promoters of the Ge- 
neral Hospital will, in their arrangements make provision for 
the Turkish bath.» 



* Bathing is utterly unknown among the Chinese. I can fully endorse 
Dr. Wilson's words in the following paragraph — he says — "of water, except in 
Slaking tea and some culinary processes, they appear to have no practical 
knowledge. Bathing, as well as ablution of the person, is unknuwn; and this 
is one of the many instances in which they differ from all other people, especial- 
ly those of the east, inhabiting warm or temperate regions. They uo unwashed 
Jiterally, from ttie cradle to the grave. The only thing in the shape of a substitute 
observed, was a cloth moistened with hot water, and passed lightly over the face 
and hands by persons, of distinction!" 



46 



SHANGHAI HYGIENE. 



Peespieation. 

This is the great means adopted by Nature for regulating 
the temperature of tlie body. An apparatus has been pro- 
vided, for relieving the body of any superabundance of heat, 
which would accumulate where the atmospheric temperature 
equals, or exceeds that of the body. By perspiration also, a 
number of deleterious substances is removed from the body, 
which if allowed to remain and accumulate in the system 
would destroy health and life. Lavoisier, and Seguin found 
that 8 grains of perspiration were exlialed from the skin of 
an ordinary sized man every minute, i.e. 33 ounces every 24 
hours, or more than one ounce every hour. Aselmino has 
made a careful analysis of perspired matter — of 100 parts 
perspired, 99 are water, and 1 is solid matter. 

Of 100 parts of this solid matter, 23 consist of salts, and 



77 of organic substance — Thus. 
Osmasome, combined with common salt. 

Lactic acid salts, with osmasome 

Animal matter, Avith vitriolic salts 

Calcareous salts , 



Thus 
48 
29 
21 
-2 



100 



parts.* 



Traces of ammonia, iron and carbonic acid gas are also 
found. Aselmino also says, "to obtain an estimate of the 
length of tube of the perspiratory system of the whole surface 
of the body, 2, 800 may be taken as a fair average of the 
numbers of pores in the square inch, and 700 consequently 
as the number of inches in length, now the number of squabe 

INCHES OF SUEFACE IN A MAN OF OEDINARY HEIGHT AND BULK IS 
2,500; THE NUMBER OF PORES THEREFORE 7,000,000, AND THE 
NUMBER OF INCHES OF PERSPIEATOEY TUBE 1.750. 000, THAT IS 

145, 833 FEET, OR 48, 600 yards, or neaely 28 miles". 
Well may the author exclaim, "what if this drainage were 
obstructed.?" This might be used as an argument in favour 
of the Tm'kish bath, in order to keep the myriads of mouths 
of these drains clean and open. Bearing on this subject, I 
shall quote from a paper which I v/rote more than two years 

* Osmasome is the animal substance which gives to perspiration its. 
peculiar odour; and to different meats their distinguishing flavour. 



SHANGHAI HYGEINB. 47 



ago, for theEoyal Asiatic Society's Journal. In the hot season, 
when perspiration is profuse, the liver is much stimulated by 
blood which has been to an unusual extent deprived of water, 
while the kidneys are affected in the same manner, by a large 
amount of saline impregnation. The functions of the skin 
too, are exceedingly active; and, during the two or three 
months of a Shanghai Summer, instead of thirty ounces of 
fluid being exhaled in twenty four hours, which is the average 
in Europe, the average amount of fluid that passes off through 
the sMn, is from seventy-Jive to eighty ounces. Thus an ex- 
cessive flow of fluids and blood takes place towards the surface 
of the body, and its temperature which has a constant tend- 
ency to rise, is kept down and modified by constant evaporation 
and chemical changes going on in the skin; — for perspira- 
tion is essentially a cooling process. When however this 
flow is excessive and long continued, the nervous system 
becomes exhausted, the heart and muscles lose their tone, 
the circulation is languid, and the organs of nutrition are 
almost paralysed. In describing the intimate sympathy 
which exists. between the skin and internal organs-especially 
the bowels and hver, and how readily one is, affected by any 
clf^nge that takes place in the other. I cannot do better 
that give Dr. Johnson's own words, "As matter of fact, there 
does exist between different parts of the body, a certain con- 
nection or relation, so that when one is affected by special 
impressions, the other sympathises as it were, and takes on 
an analogous action. Of the sympathies here referred to, 
none is more universally remarked than that which subsists 
between the external surface of the body, and the internal 
surface of the alimentary canal. 

It will be found on experience, that the loss of tone in the 
extreme vessels of the surface, consequent on excessive, or long 
continued perspiration, is accompanied, or soon succeeded, by 
a consentaneous loss of tone in the stomach, and will fairly 
account for that anorexia, or dimimished appetite, which we 
seldom fail to perceive soon after entering the Tropics, or in- 
deed during hot weather in England. Now this, though but 
a link in the chain of effects, seems a most wise precaution of 
Nature, to lower and adapt the irritable, plethoric European 
constitution to a burning chmate, by effectually guarding 



48 SHANGHAI HYGIENE. 

against the dangerous consequences of repletion. This view of 
the actual subject, will set in a clear light the pernicious 
effects of stimulating liquids, acting on an organ already- 
debilitated; probably for salutary purposes, and goading it 
thereby to exertions beyond its natural power, producing a 
temporary plethora and excitement, with a great increase of 
subsequent atony. 

If by walking for instance, or any other bodily exei'cise in the 
heat of the sun, during the forenoon, or near the dinner hour, 
the perspiration bs much increased, and the extreme vessels 
relaxed, we find on sitting down to table our appetites 
almost entirely gone, until we take a glass of wine or other 
stimulating fluid to excite the energy of the stomach. Ob- 
servation and personal feeling have taught that, in hot 
climates, jjerhaps during hot weather in all climates, an 
hour's cool repose before dinner is highly salutary; knd if on 
commencing our repast, we find we can not eat without 
drinking we may be assured, that it is Nature's caveat, to 
beware of eating at all. This will be deemed hard doctrine 
by some, and visionary by others; but it is neither the one 
nor the other, and those who neglect or despise it may feel 
the bad consequences, when it is too late to repair the erroi^" 

Lichen Tbopicus, oxPricldy Heat — Very few people escape 
the annoyt.-.ce of this eruption during a Shanghai summer, 
though it is usually more severe the first year or two. Dr. 
Johnson says, "The sensations arising from prickly heat are 
perfectly indescribable, being compou:nded of pricking, it- 
ching, tingling, and many other feelings for which there is no 
appropriate appellation. It is usually but not invariably, 
accompanied by an eruption of vivid, red, pimples not larger 
in general than a pin's head, which spread over the breast, 
arms, thighs, neck and occasionally along the forehead close 
to the hair. The eruption often disappears to a certain 
degree when we are sitting quiet, and the skin is cool; but 
no sooner do we use any exercise that brings out perspiration, 
or swallow any warm or stimulating liquid, such as tea, soup, 
or wine, than the pimples become elevated, so as to be dis- 
tinctly seen, and but too sensibly felt". 

If not caused, prickly heat is certainly aggravated by 
excessive bathing; more esj)ecially if a rough towel is freely 



SHANGHAI HYGIENE. 49 

used on the skin, after the bath. Scratching should never 
be employed to relieve the itchiag sensation, for thereby 
matters are made worse; the already relaxed and tender skin 
is torn, "excoriations," Bontius says "frequently follow, 
which prove rebellious to every form of treatment." 

Exercise, producing excessive perspiration is another cause 
of prickly heat, and hence perspiration should be modified. 

Prickly heat is a symptom, (not a cause) of good health; 
the cold bath does not repel it. Its sudden disappearance 
is not necessarily a suspicious or dangerous symptom. Hill- 
ary says, "the eruption should be favoured by the use of 
warm diluents, tea coffee, &c." Dr. Johnson with much 
more reason, sees no advantage in suffering from such a di- 
sease, and to prevent it entirely, he advises Europeans 
arriving in India and warm climates, to clothe themselves 
lightly, to avoid all exertion during the heat of the day, to 
live temperately &c. Sir J Martin says, .the eruption is 
seldom repelled by the cold bath; but he would not recom- 
mend cold bathing, even in persons of robust constitutions 
recently arrived in the country, and who are in the enjoyment 
of good health. Eine chalk, hair powder, and lime juice are 
recommended as external applications; but they are of very 
little benefit. 

The use of the punka to modify perspiration, is of all reme- 
dies the best and safest. It removes the heated air which 
surrounds the body, without exposing it to the dangers of 
thorough draughts or changes of temperature. 

The liver 

Is the largest organ in the body; and no organ is more in- 
fluenced by temperature, diet, drink, perspiration, clothing, 
and exercise. Ceteris paribus, a high temperature accelerates 
the biliary secretion, and a low temperature modifies or retards 
it. Wine, beer, and other alcoholic liquors will also/or a 
time increase its secretion. That a high temperature stimu- 
lates the liver and increases the secretion of bile, all writers 
are agreed; also that diseases of the ;liver are more prevalent 
in warm climates, than in cold or temperate ones. 

The experiments of Lavoisier, Prout, Crawford, Eyfe, 
Seguin, Copland and others prove; that the quantity of 



■50 SHANGHAI HYGIENE. 

carbonic acid exhaled fi-om the lungs in a given time, is much 
diminished in a "warm atmosphere; also, that in a warm, 
moist, malarious atmosnhere like this in Shanghai during 
the summer, not more than half the quantity of carbon with 
its combinations, are evolved from the blood by the respira- 
tory process, as when the air is cold and dry; all depressing 
passions also, and every thing which tends to lower the vital 
powers, reduce the amount of carbonic acid gas exhaled from 
the lungs. 

It must follow therefore, that during the summer in 
Shanghai, more carbon with its inj urious combinations, remain 
in the blood, and circulate in the body, because, the quantity of 
carbonaceous materials j)assing into the body is not dimin- 
ished; and if no provision is made, if no vicarious channel is 
j)rovided, for the elimination of these pernicious substances, 
the blood -would cease to undergo those changes which are 
essential to health. Poisonous elements would circulate in 
the body, pure vermilion-coloured arterial blood would dis- 
appear, and black, thick, venous blood, would take its place; 
the appetite would first diminish, there would be a constant 
feeling of nausea with occasional vomiting, and diarrhoea, the 
eyes would lose their brilliancy, the complexion would be dark, 
with an anxious expression, the exhalations from the skin, 
and the breath would becoftie offensive, low typhoid fever 
would supervene, with obstinate diarrhoea or dysentery. The 
poisonous elements in the blood acting on the brain would 
cause wandering of the mind, \fith more or less delirium, the 
vital powers would rapidly sink; and coma and death would 
close the scene. Many cases, exactly similar to this occur in the 
Chinese Hospital every summer. I have seen such cases also 
among Europeans. 

Nature* however, ever watchful, and if not opposed and 

* By Nature I mean an assemblage of causes, which are directed to per- 
form certain operations, and produce certain effects or results, in the wisest 
manner — In other words, the Great Author of all wisdom and power, who 
directs the greatest and most minute proceedings throughout the whole frame 
of the universe; and who by fixed laws for suns and systems, as well as for 
grains of sand, and minute molecules of matter, makes every bodily organ oper- 
ate, as if it were endowed with reason and intelligence. "Nature in man "says 
Hippocrates, "is the aggregate of all things that concur to perfect health, and 
the foundation of all right reasoning .ind practice in physic." 



SHANGHAI HYGIENE. 51 

thwarted, ready to provide for every contingency, makes 
provision here to meet the emergency, and to relieve the 
system of injurious substances; for, immediately when the 
lungs cease, on account of the warm atmosphere, to eliminate 
in sufficient quantity impurities from the blood, these impure 
materials are turned into other channels; the largest propor- 
tion is sent to the liver, which becomes stimulated, and adapts 
itself to new duties, and pours out bile in large quantities. 

Thus the deficiency of the function of the lungs, in a high 
atmospheric temperature, is met, by the liver performing 
vicariously, that which a high, moist temperature has rendered 
the lungs unable to do; and thus, while the function of the 
lungs is modified and diminished, that of the liver is in- 
creased and stimulated. It will be obvious therefore, that 
under these circumstances, great prudence should be exercised, 
and care should be taken, not to stimulate the liver by 
alcoholic beverages, or by too much variety of stimulating 
food; at first especially the more simple our food and drink, 
the better will be our health, for if the liver is too much 
stimulated, — one of two consequences will result; either e'n-' 
largement and chronic inflammation of the organ, or a reaction' 
will take place, and little or no bile will be secreted; and this' 
last condition suddenly supervening is, I am strongly in- 
clined to believe, one chief cause of Asiatic cholera; because, 
in thus terrible disease, no bile seems to be secreted, hence the 
so called 'rice water stoolg' without a trace of bile, with 
sudden, and in too many cases fatal collapse. 

"Diet and regimen", says Dr. Copland, "next to tempera- 
ture and 5limate, are most productive of hepatic disorders. 

Eating largely or frequently, especially of animal, rich, 
and highly seasoned food; stimulating the appetite and palate 
by a variety of incongruous dishes, and sauces, and spices, 
and wines, particularly in warm countries, and seasons, are 
most influential causes of disease. It is probably owing to 
such full and stimulating diet, that hepatic disorders are 
more common in the ofiicers than in the troops serving in the 
West Indies. 

The use of spirituous or other intoxicating liquors, especi- 
ally in excess, is prodlictive of the diseases of this organ — in 



52 SHANGHAI HYGIENE. 

warm climates, of the more acute; in temperate countries of 
the more chronic and structural maladies". 

I shall only mention three conditions peculiar to the liver 
in this climate; and I may state that each of these conditions 
assumes all kinds of modifications, resulting from individual 
temperament, constitution, diet, drink, exercise, clothing, 
habits, the regulation of the passions &c. I can ordy mention 
each of these briefly in a work like this. 

I. Uxcessive secretion of bile — This is the common result 
as already stated of removing from a cold to a hot climate; al- 
though that vague and indefinite word "bilious", is put 
forward as the cause of every uneasy symptom, and made the 
scapegoat of every disorder, even by medical men. Dr. Copland 
says, "Diminished secretion of bile, increased secretion of bile, 
secretion of morbid or altered bile, are all three denominated 
bilious, without any precise idea being annexed to the term, 
which has, even by professional 2y^'>~^ons been applied to 
a diminished secretion of bile, equally with an increased 
secretion." Keferring to these bilious Empirics, Dr. Aber- 
crombie says, "I have no hesitation in saying that mercury is 
often used in an indiscriminate manner, and with very un- 
defined notions as to a certain specific influence which it is 
believed to exert over the morbid conditions of this organ. 
If the liver is supposed to be in a state of torpor, mercury is 
given to excite it, and if it is in a state of acute inflamamtion, 
mercury is given to moderate the circulation and reduce its 
action. Effects the most indefinite, if not contradictory are 
also sometimes ascribed to it, in regard to its influence on 
the secretion of bile, and in those affections which are com- 
monly called bilious." Dr. Copland, says "Ingenuity cannot, 
possibly devise a more successful method of converting a 
healthy person into a confirmed invalid, of destroying many 
of the comforts of existence, and of occasioning hypochon- 
driasis and melancholy, than the practice of prescribing 
large doses of calomel on every trifling occasion, or when the 
bowels require gentle assistance; or because the patient 
erroneously supposes himself to be bilious, or is told so, by 
those who should know better." The same distinguished 
writer ascribes the lapse of occasional indigestion into confirmed 
sricture of the rectum, and of hcsmorrhoidal affections into 



SHANGHAI HYGIENE. 53 

fistulae, to the fi-equent and injudicious use of calomel for the 
removal of mere occasional derangements of health. 

"There is one circumstance, says Sir J. Martin, which ought 
to he impressed every wheie on individuals and communities ; 
and that is, that however useful medicine may he, in mod- 
erate and judiciously administered dosed, under occasional 
changes of circumstances and climate or season, or during 
the prevalence of certain epidemics; it is yet more on the 
proper selection of localities; the avoidance of day and night 
exposure, care in diet, clothing, exercise &c; in short, on the 
adoption of all those well-known measures of avoidance, whe- 
ther affecting individual hahit of life, cr those moi'e general 
predisposing causes of disease, now so well understood, that 
the prevention of disease depends; and not on a system of self- 
quackery, with calomeland othermercurial preparations, such 
as many persons pursue in England, and in India too, to their 
great injury, for the removal of what they call biliousness. 

Many is the robust habit I have seen destroyed by this 
senseless custom; and I have known several lives lost, and 
others put in jeopardy by the use of saline purgatives dming 
seasons of cholera. 

Another source of destruction to healtJil must here m'ention, 
as it has freq^uently come under my notice, both in England, 
and in India. — I mean the long-continued use of aperient 
medicines containing the mercurial preparations. Patients 
frequently obtain from their physicians aperient pills, for in- 
stance, containing some blue pf 11, or calomel. They may have 
been given, with a particular view, or for a special occasion 
only;butitoftenhappensthat the patient continues for months, 
or even for years, that which was intended to be used for days 
or weeks. The results are very lamentable. I have seen 
persons in a state ofnervous irritability bordering on insanity, 
from this cause, with sub-acute inflammation of the mucous 
digestive membrtme, and ptyaKsm — aU resulting from long- 
continued and unconscious use of mercury. A field officer 
used blue pill and colocynth for two years and a half; and an 
American gentleman took the same preparations, with ipeca- 
cuanha, during a voyage from Madras to America, and back 
to Calcutta. It is quite needless to detail how utterly ruined 
was the health of both." 



54 SHANGHAI HYGIKNE. 

Dr. Paris tells us, that "if the truth were told,_ a large 
proportion of dyspeptics seek the advice of a physician, not 
so much for the better adjustment and regulation of their 
diet, as for the means by which they may counteract the ill 
eifects of their indulgences, hence the popularity of those 
"antibilious" remedies, which promise to take the sting out 
of their excesses, and enable the unhappy dupes to fondle and 
play with vice as with a charmed serpent." 

As a rule, the biliary secretion is in excess during the hot- 
test season, hence bilious diarrhoea, or what is known as 
English cholera is apt to prevail; excess of bile irritates 
the stomach and bowels, producing vomiting, and a more 
rapid passage of substances through the intestinal tube, with 
severe griping pains and straining; pr.oducing in short the 
same effects as a large dose of an irritating purgative-medi- 
cine. The best way to modify the excessive secreti on of bile, 
is to observe moderation in eating and drinking. Those 
especially who arrive during the summer, should be very 
sparing in the use of highly seasoned dishes, and in beer 
and wine; and also to modify as much as possible without 
checking the perspiratory process, for it will be found that the 
most intimate relation, and the strongest sympathy exists, 
between the perspiration and the secretion of bile. "That 
these two functions says Sir J. Martin, "are regularly, and to 
appearances equally increased, or at least influenced by one 
particular agent, atmospheric heat, from the cradle to the 
grave, from the poles to the equator, will be readily granted 
by every observer; and as the state of the perspiratory process, 
is a visible and pretty fair index to that of the biliary; so every 
precautionary means which keeps in check, or moderates the 
profusion of the former discharge, will invariably have the 
same effect on the latter; and thus tend to obviate the incon- 
venience, not to say disorders arising from redundancy of the 
hepatic secretion. To this rule I do not know a single 
exception, consequently its universal application can never 
lead astray in any instance.' 

The practical lesson from all this is, to avoid violent 
exercise, which will increase the perspiration, and therefore 
the biliary secretion; and where practical to use the punka, 
which is one of the best means of preserving health in the 



shan6hai hygiene. 55 

East in hot weather, as it does not cool th§ air; only chang- 
ing rapidly the hot particles in contact with the body, and 
thus imparting a feeling of coolness and comfort. 

77. Diminished secretion of bile. As heat and high living 
increase the biliary secretion, so cold and spare living tend 
to diminish it. The most common cause however, of torpid 
liver in hot climates, is the undue excitement of that organ by 
eating and drinking stimulating articles, as pickles, hot curries, 
variety of wines &c. By these means the liver is for a time 
over stimulated ; afterwards, by an infallible law in physiology, 
a reaction takes place, and the liver will scarcely secrete a 
particle of bile ; and thus some formidable diseases are induced, 
requiring powerful remedies to overcome them. Exposure 
to cold, neglect of exercise, indolent habits, draughts of cold 
fluids, over fatigue, great humidity or malaria, neglect, or 
inattention to the due evacuation of the bowels &c. 

When the vital energy is depressed, impaired, or exhausted 
by intemperance in eating or drinking, or by long residence 
in a hot or unhealthy climate, the blood vessels of the liver, 
become gorged and congested; what bile is secreted accumu- 
lates in the gall bladder, and hepatic ducts, and thus, with 
partial congestion, and accumulation of vitiated bile, enlarge- 
ment of the organ takes place, and acute or chronic inflamma- 
tion, with all its serious concomitants and consequences is apt 
to supervene; and then when enlargement and other disease 
of the Kver is present, good bUe cannot be secreted; it is viscid, 
tenaceous, and otherwise depraved, and moves along the bile 
ducts with difficulty; digestion is not good, the bowels are 
costive or irregular, the stools are pale or clay coloured, the 
urine is thick and dark, with much sediment when cool; the 
patient is drowsy, low spirited, has a full tongue, bad taste in 
the mouth, no appetite, towards night is often feverish, at 
other times chilly, with a feeling of fulness and tenderness over 
the stomach and liver. He wiU sometimes also have shoot- 
ing pains in the head, and soreness over the eyebrows, the 
appearance of the countenance and skin will be muddy, sal- 
low, and dark about the eyes; all these symptoms maybe 
present, and yet the patient be carrying on his usual work; 
but I need not say that his case is bad, and that careful and' 
judicious treatment is necessary tarestore him to health. Speak- 



56 SHANGHAI HYGIENE. 

ing of this disease, Dr. Copland truly says, that it is aggrava- 
ted, and the constitutional powers injured, by the emperical 
and routine practice of bleeding, mercurializing, over dosing, 
and ov'-r drugging. 

Torpor of the liver usually takes place by degrees. When 
hov'cvev it has been for some time stimulated by rich, heating 
food, and generous wines, a sudden and complete suppression 
often takes place. Being thus goaded on by rich food in 
great variety, the nervous influence, or vitality of the liver, 
stomach, and duodenum, whicii act reciprocally on each 
other, seems to be exhausted, a reaction ensues, spasm of 
tho capillary vessels and bile ducts supervene; and then we 
liavo all the symptoms of pestilential, or Asiatic cholera, 
witft sudden collapse, and great tendency to death. 

Several cases of this sort occurred in Shanghai last sum- 
mer and autumn. Some will remember two or three such 
cases occurring in individuals, within a few days after their 
arrival from England per Mail Steamer. In other cases, the 
reaction takes place more slowly, the liver continues to secrete 
bile, but in a modified and irregular manner. Materials 
which ought to form bile, are not all separated from the 
blood, but continue to circulate in the body, producing chills, 
or ague. 

There is also more or less spasm of the biliary ducts, and 
particles of bile are found in the circulation, producing 
Jaundice. This is a common result during the autumn 
here, both among Foreigners and Chinese. .The hot days 
and cold nights in September, and October, modify the 
secretion of bile, and produce irregular and spasmodic action 
of the biliary apparatus. How careful therefore ought we 
to be, to maintain a steady ecLuilibrium, not only of the 
liver, but of aU the digestive organs; also to guard against 
chilly nights, and changes of temperature. 

Ill Secretion of vitiated bile. This may occur both 
in an active, and torpid state of the liver. If the blood is 
impure or morbid, healthy bile cannot be secreted, moreover 
bile may be good when secreted, and become vitiated, in the 
gall bladder or hepatic ducts. In some post mortem exam- 
in.'.tions which I made in the Chinese Hospital, of patients 
wJi.o died of liver and bowel complaints, the bile was pitch- 



SHANGHAI HYGIENE. 57 

like in colour and consistence, wliile in others it was dark 
green, and so acrid that when put upon the back of the hand, 
it made the skin smart like mineral acid, or strong tincture 
of iodine. 

From this, -some idea might be formed, how such bile 
would irritate, if not destroy, the delicate mucous membrane 
of the bowels. In other cases the bile was watery, pale, and 
albuminous, and in some it had a greenish brown colour. 
Now, each of these modifications of vitiated bile, will produce 
different symptoms, — from undefined uneasy feelings, slight 
nausea, headache, and low apirits, to the most violent vomit- 
ing, colic, cholera, and dysentery. Speaking of the symptoms 
which vitiated bile produce, Dr. Johnston says, "after a 
debauch, the chyme passes through the pyloris into the 
duodenum, in a state less fit for chylification than during a 
seasonof temperance andregularity; so that, during the increas- 
ed secretion and subsequent inactivity in the liver, the bile 
passes out into the intestines deteriorated in quality, as well 
as superabundant in quantity. 

In what this vitiation consists it is certainly not easy to 
say. In high degrees of it, with hurried secretion, both the 
colour and taste are surprisingly altered, since it occasions 
all the shades between bottle green and jet black; possessing 
at one time an acidity that sets the teeth on edge; at other 
times and more frequently, an acrimony that seems absolutely 
to corrode the stomach and fauces, as it passes off by vomit- 
ing; and, when directed' downwards can be compared to no- 
thing more appropriate than the sensation which one would 
expect from boiling lead flowing through the intestines. Many 
a time have I experienced this, and many times have my pa- 
tients expressed themselves in similar language. The slightly 
disordered state of the hepatic functions, which we are now 
considering as primary effects of climate, and within the 
range of health may be known by the following symptoms: — 
Irregularity in the bowels, with motions of various colours, 
and foetid or insipid odour; general languor of body and mind, 
slight nausea, expeciaUy in the mornings, when we attempt 
to brush our teeth; a yellowish fur about the back part of the 
tongue; unpleasant taste in the mouth on getting out of bed; 
a tinge in the eyes and complexion from absorption of bile, 



58 SHANGHAI HYGIENE. 

iiie urine high-eoloured, and a slight irritation in passing it, 
the appetite impaired, and easily turned Eigainst fat or oily 
victuals, irritahility of temper; dejection of mind; loss of flesh; 
and disturbed sleep. 

These are the effects then of increased and irregular secre- 
tion of hUe, and may appear in aU degrees, according as we 
are less or more cautious in avoiding the numerous causes 
that give additional force to the influence of climate. 

If, for example, I use more than ordinary exercise, expose 
myself to the heat of the sun, or drink stimulating liquids 
to-day, an increased and vitiated flow of bile takes place, and 
to-morrow produces either nausea or sickness of stomach, or 
a diarrhcea, with gripings and twltchings in the bowels'. 
But a slight degree of inaction or torpor succeeding both in 
the liver and intestines; there wiU probably be no alvine 
evacuation at all the ensuing day, till a fresh flow of bile 
sets all in motion once more. These irregtdarities, though 
they may continue a long time without producing much 
inconvenience ; especially if they be not aggravated by excesses, 
yet they should never be despised, since they inevitably, 
though insensibly, pave the way for serious derangement in 
the biliary and, digestive organs, especially in hot climates, 
unless counteracted by rigid temperance, and proper prophy- 
lactic measures." . 

Bile is a very elaborated substance, *secreted by cells in a 
highly organized state; it is formed from materials which do 
not pre-exist in the same conditions in the blood. It is essen- 
tially different from those secretions which are formed to be 
discharged from the body, as carbonic acid, urine &c. It 
resembles more the higher kinds of secretions, which are 
designed to serve some important purposes in the system, 

* Berzelius ha^ analysed 1000 parts of human bile as follows — 
Water - . 908.4 

Picromel- - . .80_ 

Albumen - . . 3. 

Soda - ... 4_i 

Phosphate of lime . . .1 

Common Salt - . . .3.4 

Phosphate of Soda and lime- . . l' 

1000. 



SHANGHAI HYGIENE, 59 

The chief purposes of bile seem to be, 1st, to aid ia the 
process of digestion; 2nd, to purify the biood; 3rd, to promote 
the secretion of the intestinal glands, and to stimulate the 
bowels in discharging their contents; 4th, by its highly anti- 
septic power, to prevent decomposition of the various kinds 
of food in the bowels ; and 5th, to convert the chyme frOm an 
acid to an alkaline substance. The purposes served by the 
bile in the animal economy may be summed up in two words, 
excrementitious and digestive. ■ 

Blondlot, Haller, Bidder, and Schmidt, differ considerably 
in their estimate of the quantity of bile secreted in the 24 
hours. The average amount in a healthy individual woulcl 
seem to be from 10-to 2Q ounces. 

SLEEP 

Is that state in which the senses, reason, will, and volun- 
tary motions are not exercised. The design and end of sleep 
is to renew the vital' energy, and to restore exhausted na- 
ture. After being awake sixteen or eighteen hours, a general 
feeling of languor and fatigue creeps over us, and we desire 
quietness and the recumbent position. In falling asleep, we 
lose the use of the senses in succession. The sense of sight 
first ceases by the closing of the eyelids, then the taste, then 
the smell, next the hearing, and last of aU the touch. The 
muscles of the limbs relax, afterwards those which support 
the head and body. The breathing becomes slower and deeper, 
the heart beats more steadily and slowly, digestion is modified, 
and the heat of the body is diminished; the secretions become 
less abundant, the metamorphosis of tissue proceeds more 
slowly; after a time all ideas, imagination, and even the con- 
sciousness of existence cease, and the individual is in a pro- 
found sleep. In the human body the centripetal & centrifugal 
forces are well balanced; but prevail alternately according to 
age, sex, the state of health, temperament constitution, 
activity or repose, the state of sleep or wakefulness. During 
sleep the internal organs act slowly; less resistance remains 
in the system, the centripetal power prevails; absorption 
proceeds rapidly, and hence we find it so injurious and dan- 
gerous to sleep in a noxious atmosphere, colds, agues, remit- 
tant, and other low fevers are induced by such means. There 



60 SHANGHAI HYGIENE. 

is less vitality in the body during sleep ; all the functions and 
operations are more languid and weak, the temperature of 
the body is lowered; and coUsequently the individual is more 
liable to impressions from without. 

Few people sleep less than six hours, and few more than 
eight; hence we sleep from a fourth to a third part of our life 
time. Some require more sleep than others; men of active 
energetic minds, or engaged in great or interesting enterprises, 
require much less sleep than the lazy and listless, with little 
or nothing to do. frebbeick the geeat, and the great napo- 
leon, and other famous generals and statesmen, required very- 
little sleep; three or four hours being amply sufficient with 
all their arduous work. On the otffer hand there are people 
who can sleep from 10 to 15 hours. I was much struck with 
two gentlemen on board the mail steamer Bengal, between 
Point de GraUe and Suez. Both occupied the same cabin and 
appeared in perfect health. The weather was fine, and they 
were at the breakfast table every morning at half past eight 
o'clock. By 10 o'clock they were asleep in easy chairs on deck, 
the 12 o' clock bell aroused them for ^i^m; immediately after 
tiffin they went to their cabins, and slept till the dinner bell 
rang at 4. During the evening they usually slept in easy chairs 
on deck; and soon after 9. p.m. they were again in bed. 

These gentlemen confessed that they slept about 18 hours 
in the 24, but that it depended on their mode of living, and 
they could do with 6 or 7 hour's sleep perfectly well. In or- . 
der to secure permanently good health, we require more sleep 
in a hot climate, than in a temperate one; as a general rtde, if 
we required seven hours sleep in England, we ought to have 
eight in China. Sound refreshing, and undisturbed repose, 
influences our health and constitution more than is generally 
supposed, Unfortunately when it is very hot, refreshing 
sleep is the exception, not the rule. Our great aim should 
be to sleep cool, and be thoroughly protected from mosquitos. 
As I said before, a cane bottomed bed with only a blanket 
over it, near an open window facing the south if possible, hut 
not in a thorough draught, wiU secure the one, and well fitt- 
ing, carefully adjusted mosquito curtains the other.' 

The less that one perspires during sleep the better. In or- 



SHANGHAI IIYGIES'E. 61 

der to secure sound and refreshing sleep during the hot 
weather, late dinners and generous wines, must be avoided." 

During the hot season in Bengal, Sir J. Martin says 
"early hours are indispensable; for the fashionable noccur- 
nal dissipation of Europe, would soon -cut the thread of our 
esistence within the tropics. The order of nature is never 
inverted witb impunity, even in the most temperate climates; 
beneath the torrid zone it is certain destruction. The hour 
for retirement for repose should never be protracted beyond ten 
o'clock; and at daylight we should start from our couch to 
enjoy the cool, the fragrant and salubrious breath of morn." 

Those who cannot sleep soundly through the night, may 
find it necessary to havemn afternoon siesta. Indeed where 
the principal meal is taken about one or two o'clock, half-an 
hour's sleep after it, may be taken with considerable advan- 
tage in hot weather. 

The Passions. 

t 

What has the physician to do with the government of the 
passions? Much every way. "Mind and matter" says Dr. 
Williams, "are too closely combined to be studied or treated 
apart. To medicine alone it belongs to contemplate, and 
to treat the entire man — physical, moral, and intellec- 
tual." I do not mean to enter into minute disquisitions on the 
subject of the passions — I would observe however, that 
metaphysicians have not been careful to distinguish between 
the passions, emotions, and affections; or that these are 
merely degrees of similar changes in the brain. For exam- 
ple, a pleasing sensation arising from the contemplation of a 
desirable object is an affection; extend this sensation which 
produced the affection, and it will rise up to admiration, and 
thus constitute an emotion; extend this emotion to a gi'eater 
degree, and it becomes a passion. 

In a medical point of view, passions are divided into excit- 
ing, calming, and depressing. Anger, avarice, pride, love, 
desire, ambition, patriotism, emulation, gambling, and surprise 

* Many people who dine late have not only restless nights, but are troubled 
also with incubus, or night mare. Nuts, cucumbers, raisins, apples, pears, 
chesnuts, sour wine, and flatulent kinds of food, are apt to produce incubus. 
Hildanus says, "Qui scire cupit quid sit incubus? Is ante somnum comedat 
castaneas, et superbibat vinum faBculentum"- 



62 SHANGHAI .IIYGIEXE. 

are exciting. Hope joy, admiration, benevolence and venera- 
tion are calming. While terror, grief, fear, jealously,^ revenge, 
envy, resentment, anxiety, and hatred are depressing. All 
these forms of passion vary in degree; the more violent pas- 
sions, as anger or rage are like the ocean in a storm; but this 
can only result from an ill regulated or badly trained mind. 

People are not aware of the great amount of injury they 
sustain, by not controlling their passions; the health and 
constitution suffer from the condition of the mind to an enor- 
mous extent. Dr. Parr says, "the more violent passions are 
sometimes fatal in a moment. The others undermine the 
constitution, weaken every function, and induce dyspepsia, 
palsy, dropsy with the whole train of asthenic diseases." Dr. 
Von Ammon relates a remarkable case, shewing how power- 
fully the bodily secretions are affected and rendered pernicious 
and deadly, even by a momentary passion; how much more 
will the secretions be vitiated, the functions deranged, and 
the health and constitution undermined and shattered, if the 
exciting cause is continued, which in various ways is too 
often done. "A carpenter fell into a quarrel with a soldier 
billeted in his house, and was set upon by the latter with his 
drawn sword. The wife of the carpenter at first trembled 
from fear and terror, and then suddenly threw herself furious- 
ly between the combatants, wrested the sword from the sold- 
ier's hand, broke it in pieces, and threw it away. During the 
tumult, some neighbours came in and separated the men. 
Whilst in this state of strong excitement, the mother took 
up her child from the cradle, where it lay playing, and in the 
most perfect health, never having had a moment's illness ; she 
gave it the breast, and in so doing sealed its fate. In a few 
minutes the infant left off sucking, became restless, nanted, 
and sank dead upon its mother's bosom. The physician who 
was called in, found the child lying in the cradle as if asleep, 
and with its features' undisturbed; but all his resources were 
fruitless. It wag irrecoverably gone." 

All well informed physicians, know how essential it is, that 
the mind of the nursing mother should be calm; that the 
passions and temper should be carefully regulated, and kept 
under control; that anxiety and fear — fits of anger and 
Iretfulness must be strictly avoided; and that a uniform 



SHANGHAI HYGIEXE. 63 

cheerfulness, and a happy disposition, are absolutely necessary 
for the proper supply of healthy milk. It is fio uncommon 
thing, for a healthy child to he attacked with convulsions 
immediately after partaking of the breast of the nurse or 
mother, during a paroxysm of excitement. 

In these cases the milk produces the same effects as a 
narcotic poison. The various kinds of passion in the mother 
or nurse, produce different effects on the child; thus, milk 
secreted during a fit of anger will irritate, cause colic, and 
produce green stools. Fretfulness will make the milk serous, 
watery; and the child will be restless, wakeful, or peevish. 
Grief or anxiety will reduce the secretion. Terror or fear, 
will cause the milk to act on the child, like laudanum or 
prussic acid. In short, every passion, or emotion on the part 
of the mother, is sure to affect the child more or less; and 
the child thus affected is merely a delicate test; shewing how 
much the mother is affected; and the mother being affected, 
every individual is affected, influenced, and injm-ed by the 
same causes. 

No man can be great unless he has strong passions. True 
greatness however consists in having aU the passions perfectly 
under control. England, France, and America are great, 
because the people have strong passions; but England is 
greatest because her people can command their passions. 
The Chinese have little passion (except those in common 
with the brutes, self jDreservation and cunning,) hence ^every 
thing is stagnant, and has a low standard. A man with 
strong passions may have perfect command of his temper, 
even under the most trying circumstances, and the greatest 
provocation; this however requires a well balanced, and well 
trained mind, and a strong will; and he must either be a 
madman or a fool, and unworthy of the name of man, who 
with only one or two feeble efforts, allows his passions to 
prevail under the plea, that they are too strong for subjugation. 
Such a man can never know what it is to be happy; he is 
not master in his own house, he is not master of himself; the 
slave of sense, and the sport of passion, he is tossed to and 
fro like a stormy sea. I appeal to every man who has not 
mastered his passions for the truth of this assertion; I appeal 
to the experience of those passed away. Out of a large 



64 SHANGHAI HYGIENE. 

number very well known, let me mention only one— Lord 
Byron — a slftve to his imssions, crouching and writhing 
under the lash of public opinion; at one time declaring his 
supreme contempt for what people said of him; at other 
times, in his better moods and more sober moments, confess- 
ing, that "the disapprobation of the meanest critic gave him 
much more pain, than the applause of all the others gave 
him pleasure." — What a contrast to Luther, or Paul, who 
declared to their enemies — "for me it is a very small thing to 
be judged of you, or of man's judgment" — Proving that, 
"He is a freeman whom the truth makes free; and all are 
slaves beside." 

There can be no real happiness until every passion is sub- 
dued, and perfectly under the control of the will; but even 
this is not quite enough, a step more is necessary for real 
and permanent satisfaction, namely, a full surrender of the 
will itself to the Author of our being; and this true and per- 
manent happiness, is within the reach of all. 

The remarks of Dr Keid on good and bad humour are 
well worthy of attention. "There is no disposition more 
comfortable to the person himself, or more agreeable to 
others, than good humour. It is to the mind what good 
health is to the body, putting a man in the capacity of enjoy- 
ing everything that is agreeable in life, and of using every 
faculty without clog or impediment. It disposes to content- 
ment with our lot, to benevolence to all men, to sympathy 
with the distressed. It presents every object in the most 
favourable light, and disposes us to avoid giving, or taking 
offence. 

This happy disposition seems to be the natural fruit of a 
good conscience, and a firm belief that the world is under a 
wise and benevolent administration, and when it springs from 
this root, it is an habitual sentiment of piety. 

The only danger of this disposition seems to be, that it 
may degenerate into l»vity, and indispose the mind to a pro- 
per degree of caution, and of attention to the future conse- 
quences of our actions. 

There is a disposition, the opposite to good humour, which 
IS called had humour, of which the tendency is directly con- 
trary, and therefore, its influence is as malignant as that of the 



SHANGHAI HYGIEKE. 65 

other is salutary. Bad humour alone is sufficient to make 
a man unhappy. It tinges every object with its own dismal 
colour; and, like a part that is galled, is hurt by every thing 
that touches it. It takes offence where none was meant, and 
disposes to discontent, jealousy, envy, and, in general, to 
malevolence". 

I would be careful to warn every man, especially those 
newly arrived, against a very common, though absurd im- 
pression, f'that there is something peculiar about the tropics 
which excites certain passions in a higher degree than in 
temperate regions." It is surprising how this erroneous belief 
seems to pervade almost all classes. These advocates for 
sensuality maintain, that in the East there is "a promptitude 
and a bias to pleasure," and an alienation from serious 
thoughts and deep reflection. "The brilliancy of the skies" 
say they, "and the beauty of the atmosphere conspire to 
influence the nerves against philosophy and her rigid tenets, 
and forbid their practice among the children of the sun." — 
Now, I would ask in the words of Dr. Johnson, who met 
with the same sentiments in India, "If this bias to pleasure 
be increased in hot climates, why is it that the ability to 
pursue or practise it is lessened.? — a fact well known to every 
debauchee." These passions are not increased in, and about 
the tropics. No man who knows any thing of the human con- 
stitution, and who has watched the effects of climate upon 
it would say so; on the contrary, this so called "bias to 
pleasure, " is very much greater in a pure, elastic, bracing 
atmosphere; than in a moist, hot, depressing, impure one; 
which all tropical climates more or less are. I happen to 
know something of men of both classes in the East; and for 
health, strength, and happiness, the strictly moral man will 
contrast most favourably with one of the opposite class. I 
have seen many suffer severely, destroy their health, happiness 
and life, by following the promptings of their unbridled 
passions; need I say, that I have never seen a man suffer 
from keeping himself pure. Matters stand thus — in the 
East many of the salutary and social restraints of home, and 
its happy influences are removed; there is greater laxity of 
moral and religious principle, the young man is often thrown 
among those who lead immoral lives, who find themselves 



66 gnANGHAI HYGIENE. 

by habit bound in fetters of vice, and wbose only happiness 
seems to be, in making every one like themselves. Sir James 
Martin says of Europeans in India, and it applies equally to 
China, "The removal of religious and moral restraint, the 
temptations to vice, the facility of the means, and the force of 
example, are the real causes of this bias to pleasure; and in 
respect to the effects of licentious indulgences between .the 
tropics, the reader may be assured that he will find, perhaps 
when too late, how much more dangerous and destructive 
they are than in Europe. 

The nature of the supposed "prospensity" has been ex- 
plained to him; and as the principal cause resides neither in 
the air nor in the "brilliancy of the skies," but in his own 
BREAST, he has no excuse for permitting it to grow into the 
wild luxuriance of unbridled excess. 

The monotony of life and the apathy of mind so conspi- 
cuous in hot climates, together with the obstacles to matri- 
mony, too often lead to vicious and immoral acts, which 
speedily sap the foundations of principles imbibed in early 
youth, and involve a train of consequences, not seldom 
embarrassing, if not embittering every subsequent period of 
life. It is here that a taste for some of the more refined, 
•and elegant species of literature, will prove an invaluable 
acquisition for dispelling ennui — the moth of mind & body."* 

The influence of public and private morals on the health 
and welfare of communities is too little thought of, for its 
power is veiy great. This is easily proved by looking over 
any table of statistics on Etiology; and it is well known 
that no accurate statistical retyrn of mental alienation exists, 

* A taste for refined and elegant literature is excellent, so far as it goes; 
but here in the great majority of cases, it will as a means, prove utterly in- 
adequate to the end in view. What use is it to talk to a man of strong pas- 
sions, about elegantliterature, and the lofty theories of his mental constitution; 
or of the utility of virtue, with its fine but indefinite disquisitious; of the 
sublime and harmonious systems of nature; or even of the danger of violating 
the moral and social laws which bind men and societies together. Passions 
when strong, aict with such promptitude as to forestall the exercise of reason. 
Reason, or the reasoning faculty, moves too slowly, to constitute an efficient 
check to the passions. Conscience is here the only safe-guard, acting as it 
does with all the quickness, power, and precision of an instinct. Conscience 
is an innate faculty, moulded and modified by early habit, and example; and if 
not suppressed or blunted by frequent acts of sin, constitutes a true index of 



SHANGHAI HYGlilNK. 67" 

which does not furnish a large number of cases, due to dis- 
sipation, habitual vice, and methodic indulgence in moral and 
physical crime. Let any one examine the wiitings of Esquirol, 
regarding the standard of morals in France in his day, and 
then doubt the influence of public and private morals for 
good or for evil, on the health of nations and communities. 
This distinguished author declares, that he could write a 
history of the French Eevolution from the character of the 
insanities, and other diseases, prevailing at its different pe- 
riods; and that the low condition of morals in France at that 
time, produced more mental disorders, than were ever caused 
by all her turbulent political agitations. The abuse of 
spirituous liQ[uors, is the next prolific cause of shattered 
health and general debility. However beneficial wine, bran- 
dy, or beer may be in moderation, taken in excess it is 
degrading and pernicious. In what way this passion is 
connected with individual organization, I am not at present 

the Divine will in the life of man; and it is the only faculty which can offer 
effectual resistance to the passions, because it is the only faculty which acts as 
promptly as themselves. 

But here there is a consideration of invaluable momenl; for just as theacuteness 
of the reasoning and perceptive faculties are strengthened and matured by exer- 
cise and habit, so the passions gain power by indulgence and habit, and the con- 
science, faithful at first, becomes seared and almost suppressed, for a time, by acts 
of transgression. We are never struck suddenly and at once, with moral im- ' 
potency-'neither the power of passion nor temptation, can take us by storm and 
keep ifii secure. The influence of guilt is gradual and progressive; every devialion 
from Ihe right way weakens the conscience, and makes us more helpless; the 
•will becomes enthralled, and we cannot resist. The progress of dishonesty, m- 
temperance, or licentiousness proceeds in this way; each refetUion makes it more 
difficult to break the spell, untU at length the wretched man is lorded over by a 
power of moral evil, wTiich possesses his whole bemg, and wields all but an 
irresistible, or rather an unresisted ascendency or sovereignty over huu. 

But there is a point of departure or divergency, where two ways meet, or, 
■where two ways commence. There is a balancing moment, when passion or 
pleasure would aUure, and when conscience promptly steps ni and urges to re- 
frain This is the moment in nine cases in every ten, when a man s career com- 
mences for good or evil, for happiness or for misery; and had there been no death 
we might have seen, standing out in bold relief, the r^ective terminations of 
these two paths— the respective consummations of virtue and of vice— we might 
have seen the world divided into two moral territories, where the character and 
habits of hundreds of years had been permanently fi/e-l-'st, a s,ociety of nght- 
cous men, who passed through a long process of disciphne, selfdenial and 
moral rectitude; now in the firm possession of all goodness: 2nd. a society of the 
wicked or reprobate, who by first disregarding conscience, gave w-ay to sin, in- 
dulged their evil passions, went on from bad to worse, till hardened miniqmty, 
their passions could no more be controlled or eradicated. Wc might h*ve seen 



68 SHANGHAI HYGIENE., 

prepared to say; yet, I believe a clue may be seized from this, 
to form in some measure a prophylaxis; the present question 
is, how does it affect the health and constitution? This 
question I shall answer in the words of Dr. Walshe. Profes- 
sor of Medicine in University College, London. Eeferring 
to the consequences of yielding to this vice he says, "This 
habit entails in the drinker himself acute and chronic alcohol- 
ism; that is, physical, intellectual, moral, and emotional 
disease and degradation of a peculiar type; on his family and 
kindred, he entails poverty, destitution and crime; on his 
stock, he engrafts the disposition to various brain-diseases^ of 
the insane group, idiocy, congenital or acquired; brutality 
of disposition, and feebleness of procreative faculty. He takes 
his part in deteriorating the very fountains of life in the 
nation tq which he belongs. Magnus Huss has shewn, that 
in Sweden the existing people have, through abuse of alcohol, 
fallen in physical strength and stature, below the standard of 
their forefathers." 



the peace, the' confidence and love, the contentent and happiness, that reigned 
in the dwelling of the righteous; and contrasted these with the misery, stnfe, in- 
justice, implacable hatred, mutual disdain, fierce collisions, and bacchanalian revelry, 
with dreary intervals of remorseful lassitude, and ever growing despair; where the 
unjust remain "unjust, still; and where the filthy remain "filthy still".. Death 
however, most effectually interrupts the view of this result, or termination of 
these two ways. But though the end is not a matter of experience, or visible to 
the bodily eye, yet of all matters this is the most likely to be anticipated; in fact , 
reason declares and even demands it; namely, that a righteous distribution of 
rewards and of punishments shall one day be meeted out, according to the deeds 
and characters of man. 

Thus have I briefly discussed this all important matter, from a comparatively 
low point of view; i e, I have only appealed to man's reason and conscience. 
But there is a flood of light brought to bear on these subjects, emphatically 
called a Divine Revelation, containing directions more than sufficient to guide 
and direct man through his pilgrimage below, as well as cheer and animate him 
in the prospect of that life wnich is to come. And if any man doubts the Divine 
principle in that Revelation, I maintain that the evidence of this is over whelming, 
that every pile of its foiMdation has been rigorously investigated , and subjected 
to the most searching scrutiny both by friends and foes; and the more these 
foundations have been investigated, the stronger has been the evidence, that 
they are what they profess to be. And that the greatest men, the most acute and 
powerful intellects, who have honestly investigated these evidences, have declared 
themselves fully satisfied that Ihe Book is divine. Here ihen, a Directory, or 
Chart is placed in man's hand to direct him during the journey of life — There 
he will find mysteries so profound, and glories so effulgent, that man's imag- 
ination cannot rise to them; but he will also find truths so simple, and prospects 
and promises so tright, that the "Wayfaring man" can fully understand them. 



SHANGHAI HYGIENE. 69 

I kave sometimes been asked why man was made with 
these strong and ungovernable passions, which are so liable 
to lead him asti-ay? I say, that question simply suggests 
another — why was man made man — why was he not made 
an angel? I can understand why a carpenter makes a ship 
here and a boat there, because my reasoning powers are equal 
to the carpenter's ; but ■ to comprehend why man's Maker 
made him what he is, my faculties and nature must be both 
omniscient and omnipotent. In other words, my reason and 
nature must be on a par with those of man's Creator, before 
I can know why this is done, and that, is left undone. Is it 
not enough for us to know, that He does all things well and 
\nsely, and that whatever He reqiiires man to do, He will 
strengthen him to do it? He has said these passions must be 
mastered; but look to, and lean on me, and as thy day is, so 
shall thy strength he ; 

There he will find general principles, which, if he applies with ordinary sagacity, 
will fully direct him in all the details of life and duty; he will also find minute 
illustrations of certain principles to guide him under particular circumstances. 

There he will find motives of the hif'hest, holiest, and most constraining 
influence; he will find there a suitable, and inexhaustible fountain of encour- 
age.iient and comfort, in the perfect assurance of sufficient strength here, and 
of reward hereafter; when there is none to comfort him it will fill his heart 
with joy; when there is none to counsel it will direct his way; when all his 
friends forsake him it will take him by the hand; in every emergency it will' 
tell him how to act; daring every danger it will grant him seciiritj^ in the 
choice of his companions it will give him good advice. It will teach him to 
"use the world as not abusing it"; warn him against conformity to it, and 
exhort him to be "transformed by the renewing of his mind." In all his dealings 
with the world, it will direct and inspire him with dignity and firmness, kindness, 
and humility — teaching him to love and respect the good, to pity and exhort 
the bad, anil to be patient toward all. It will tell him to court no man's ta- 
vour, and to dread no mrai's frown: and in his business or profession, whatever 
it may be, it will exhort to diligence and prudence, integrity and faithfulness, 
fervency of spirit serving the Lord. In all his social and public duties, as a 
member of society, and a member of the church, this Book will give him lull 
directions — full information regarding his duty and relationships towards his 
Maker and his fellow-men; and over and above all, it proclaims and declares 
full and free salvation for him through the merits of agDthcr; that "the blood 
of Jesus Christ cleanseth from all sin" — that "whosoever cometh shall not be 
cast out," that "whosoever will, may take of the water of life freely; that a 
sure and everlasting inheritan-ce is laid up for him — "A house not made with 
hands eternal in the heavens." 



70 SHANnirAI niTilKXK. 

GENEBAL- EEMAKKS. 

The various sciences may be placed in two great divisions, 
namely, the exact, and the ivexact. All the exact sciences 
pcjssess a priraitiA'e fact, m- law, which being applicable to the 
whole range of jilienomena, ensures perfect harmony through 
all its different parts, and all its deductions are conclusive 
and accurate. All the physical sciences have this primitive 
tact, in what is called the law of gravity. Astronomy, Navi- 
gation Chemistry &c, belong to the exact sciences. The 
inexact sciences have no primitive fact or law; they have 
merely groups of phenomena, which may, or may not be 
governed by a particular law. The sciences of Medicine and 
Agriculture belong to this division; means which apparently 
produce the same effect at one period, will fail to do so at 
another. In agriculture no man however skilful, can culti- 
vate the soil and be sure of the same result on every occasion; 
and, both in agriculture and the practice of medicine, there 
arc many circumstances over which we have no control, 
which are liable to destroy, or to shew the fallacy of our 
best calculations; and this, even after we have fulfilled every 
possible condition, and exercised every possible degree of 
prudence and sagacity to ensure success. The great object 
of the .cultivators of medicine since the days of Hippocrates, 
has been, and still is, to render medicine an exact science; 
great progress has been made during the last two hundred 
years. Of late years especially, immense progress has been 
made in physiology, pathology, histology, etiology, and 
therapeutics; nevertheless, medicine as yet possesses no pri- 
mitive fact, so as to constitute it an exact science; still its 
present state is eminently progressire; and judging from the 
flood of light lately thrown on our science by the broad, 
beautiful, and accurate generalizations of Schwann, Schleiden, 
MuUer, and Bro^TO Sequard, the time will soon come when 
the science of medicine will be exact. It must be remem- 
bered, that prior to Newton's time, physical science was in 
the very same state as medicine is now; that before the days 
of Lavoisier, Chemistry was not an exact science; but science 
advanced, facts were accumulated, till at length a Newton 
and a Lavoisier discovered the primitive facts. And so it 



SHANGHAI HYGIENE, 7l 

will be in regard to medicine; a time will come, tlieman will 
come, who will discover an ultimate fact, and thus place the 
science, now imperfect, among the perfect and exact. Let 
no one be astonished that it is not so already. Of all the various 
science's, medicine is one of tb" must exlt-nsive and compli- 
cated; in the words of Dr. Williams, "She leviesher conirlbii- 
tions IVoi/i every branch of knowledge. The hmiran Ijody 
exhibits :i machinery so perfect, that the most skilful 
mechanical philos'^pher may take lessons from studying it. 
It contains a laboratory so diversified, and chemical processes 
so subtle, that therein the ability of the most expert chemist 
is far surpassed. But the knowledge of the student of 
medicine must go beyond that of the mechanical and chemi- 
cal philosoplier. He must study those vital properties, of 
which they cau tell him nothing. He must become acquainted 
with the attributes of life operating in matter; in animal 
generation, nutrition, growth, secrerion,motion, and c-c-nsai ion; 
in the variation of these processes, in their decay and in 
their cessation which is death; he has a complicated study, 
peculiarly his own, in addition to those of a more elementary 
nature. He has besides, to contemplate the body under 
disease, and to bring to hirf aid the three kingdoms of nature, 
and almost every art, and every science, foragents*and means to 
counteract, and control that .which disturbs its well bQJng."* 
And yet, with all her breadth, depth, and diversity of 
knowledge, I maintain, that medicine as a profession, is aa 
sure and certain — if not more so, as the profession of law or 
of arms; the former is notoriously uncertain; and let any one 
look ac America, or China, Japan, or even Poland, and swear 
by the certainty of the latter. Humanly speaking, law and 
arms will never hi perfect or exact; but there is every reason 
to believe that medicine will. But to be practical. In the 
present state of things we have one great and true priiiciple 
to rest upon, viz, that in the practice of .i:idicine, the^ a is a 
right and a wrong way — there is this to be embraced as good, 
useful, and salutary; and there is that to be avoided as useless, 

* Medicine is a science, which "has man as a compound of mind and 
matter, for its subject: and an infinite variety of substances derived from the 
animal, vegetable, and mineral kingdoms for its instruments. * 

PercivaVs Medical Ethics. _ 



72 SHANGHAI HYGIENE. 

Lad, and pernicious. Hence, it will be readily observed, ho w 
vitally important it is for a physician to have clear judgment, 
good sense, justness of mind, and great power of observation. 
Locke was much impressed with this, for he says, "Nipely to 
observe the history of diseases in all their changes and circum- 
stances is a work of time, accurateness, attention and judg- 
ment; and wherein if men, through prepossession or oscitancy, 
mistake, they may be convinced of their error by unerring 
Nature and matter of fact." Few people are aware of the 
difficulty of true, simple, and accurate observation; exact ob- 
servation would seem to be the exception and not the rule — 
Buffon says,"Il y a une espece de force de genie, et de courage 
d' esprit, a pouvoir envisager sans s' etonner, la Nature dans 
la multitude innombrable de ses productions, et a se croire 
capable de les comprendre et de les comparer; il y a une 
espece de gout, a les aimer, plus grand que le gout qui n' 
a pour but, que des objects particuliers, et I'un peut dire, 
que r amour et 1' etude de laNature, sujipose dans 1' es2)rit 
deux qualites qui paroissent opposees, les grandes vues d' 
un genie ardent, qui embrasse tout d' un coup-d'oeil, et les 
petites attentions d' un instinct laborieux, qui ne s'attache 
qu a un seul point." Both in the treatment and in the pre- 
vention of disease, just and accurate observation is essential 
to ensure success — In forming an opinion of the climate of 
any locality and of the effect that climate is likely to produce 
on certain constitutions, and on the various forms of disease, 
honest, accurate and patient observation are especially 
requisite* 

Little or nothing has been written of any climate in 
China; and although Shanghai has been largely frequented 
byForeigners during the last 18 or 20 years, nothing has been 
said of the climate, beyond its being "a trying climate;" or "a 

* Indeed, only a ft,w seen to be at all capable of such observation. For 
example, the opmion of a physician residing at one of the largely frequented 
ports on the Chinese coast, was recently asked regarding the suitability of the 
said port, for a patient suffering from a well known and well understood disease, 
wrote to this effect — "After seeing you.., I consulted with my Partner, and we 
agree, that this locality may be, and perhaps is, favourable for such a complaint, 
but we cannot recommend It." — a physician in London, if forced to give an 
opinion of the sanie locality might have used the same words, namely, that as he 
knew nothing about the climate of the place in question, he could not recom- 
mend it — 



SHANGHAI HYGIENE. 73 

very flat locality;" or something equally vague and indefinite: 
and although hosts of medical practitioners have resided at 
this port, professedly to treat disease, they have done nothing 
to prevent disease, the more important of the two — Here I 
shall insert copious extracts from a paper on climate, printed 
for the North China Branch of the Royal Asiatic So6iety's 
Journal, which may be both interesting and useful to many 
people at the present time.* Two cities, even in the same 
degree of latitude and of the same elevation, may be diame- 
trically opposite in climate; and it is highly desirable that 
everyone, who visits a new locality, should know "ichat 
ought to he observed," in order to be able to pronounce that 
locality healthy or the reverse.f 

Great diiferences of opinion prevail as to what constitutes 
a good or a bad climate; and this, I think, is principally ow- 
ing to neglect of the above rule, but partly to a too limited 
view of so vast a subject, and perhaps partly, also, to indi- 
vidual experience, since the same climate will be found to 
kill one man while it cures another. 

One man for example, has no other idea of climate than 
that of a locality, situated on a certain degree between the 
equator and the poles. Another confines his attention to a 
certain degree of elevation above the level of the sea. A 
third declares that climate is influenced only by local eleva- 
tion and latitude. A fourth, to make up his opinion, asks 
for nothing more than a well-arranged table of thermometric, 
hygrometric, and barometric degrees; while a fifth declares 
that Hankow is very unhealthv, because the river overflows 
its banks, and the streets of the city are covered with water. 
Now, with all deference, I must say, that all these views are 
much too limited for a subject so comprehensive, and which 
is based on principles in physical science so subtle and refined 
as that of climate. I believe it is impossible to take too 

* MaUe. Brun says, "Physical climate comprehends the degree of heat and cold, 
the drought and humidity, and the salubrity which occur in any given region 
of the earth" 

Hooper says, "Climate is tne prevailing constitution of the atmosphere; relative 
to heat, wind, and moisture peculiar to any region. ' ' 

t Article xii — Notes on some of the physical causes which modify 
climate; By James Hekdebson, M. D. Read before the Society, 31st, 
Jlay 1861. 



74 SHANGHAI HYGIEXE. 

comprehensive a view of physical climate, and the influence 
which it exerts on individuals of different constitution and 
temperament. Many have the idea that man's body can 
resisttheinjuriouseffectsof climate better than that of any 
other p,nimal, except perhaps the swine's. I am convinced 
that this is an error, if all things are taken into account. 
Dr. James J ohnson, whose experience was great in this matter 
says: "It is evident that nature does not operate more power- 
fully in counteracting the ill-effects of climate on man than 
on any other animal; it follows, that we should not implicity 
confide, as too many do, in the spontaneous efforts of the 
constitution, but on the contrary call into its aid those arti- 
ficial means of prevention and amelioration which reason 
may dictate and experience confirm; in short, that we should 
study well the climate, and mould our obsequious frames to 
the nature of the skies under which we sojourn." 

Great variety of climate must be found in different localities 
in a portion of the earth's surface so very large as that of 
Northern China. A distinguished authority in England, 
writing on the climate of Devonshire and Cornwall, observes 
that these counties not only possess a climate different from 
any other part of England, but the different parts of these 
counties differ widely from each other. How much more 
will the climate vary over a space which embraces about 
one-fifteenth part of the whole habitable globe.'' Surely a 
subject which so powerfully influences man's health, and 
consequently his happiness, demands all the attention and 
the most careful investigation which we can possibly give 
to it. 

I shall state, very briefly, what I consider some of the 
principal physical causes which modify climate; I do so ad- 
visedly, having carefully considered the subject, and I believe 
there will be found, in China, little short of all the varieties 
of climate suitable for invalids of every class, with different 
diseases, and different stages of the same disease, that are 
known in Europe, provided the localities here are carefully 
selected. 

It is easy to lay down certain principles, founded per- 
haps partly on experience, and partly on theoretic grounds, 
and by the aid of these, we may in a general ivay determine 



rniAN-lilTAI IIYGTEXE. T.T 

the nature of a climate and its peculiar influences on diifer- 
ent individuals. But it is not so easy to determine accurately, 
without much investigation, because of the nice shades of in- 
fluence which are capable of modifying in a surprising degree, 
the instruments with which we make our observations. 
Besides the major influences, which no careful observer will 
overlook — such as direct sun light, warm exposure, reflected 
and radiated heat, currents of wind, raui, &c., — thei-e are 
ever varying conditions, which, unless carefully watched, will 
produce marked differences and modifications on the instru- 
ments we use: for instance, two thermometers, placed within 
five hundred yards of each other, may show a difference of 6 
or 8 degrees of heat for several days together, simply because 
one is near the surface of the earth or in a sheltered situation, 
while the other is elevated and exposed to currents of wind 
or rain. Now, under such circumstances, if one instrument 
only is employed, a very inaccurate idea may be formed of 
the locality; and this shows the necessity of mutiplying 
observations, and of carefully watching all modifying in- 
fluences.* 

The principal particulars which ought to be observed in 
forming an estimate of physical climate are these, namely: — 

TeinperaUire ; Humidity ; Geological Nature of the Soil; 
Drainage and Cultivation ; Proximity of Sea and Rivers; 
General and local Elevation ; Position of Mountains; 
Prevalent Winds; General and local Aspects; Trees and 
Vegetation. 

Besides these, if we v/ish to arrive at anything like accu- 
racy, many other points must be observed, as perpendicular 
pressure of the atmosphere, electricity, the purity and tran- 
sparency of the air, the quality of the water, the ozon^, the 
moral condition of the people, their degree of intelligence, 
appearance, &c., whether or no there be many aged people 

* Erroneous notions are apt to be formed of certain places for want of proper 
investigation. The rate of mortality among the English troops at Hongkong 
presents a striking example of this. In the years 1842 and )843 the deaths were 
from 19 to 22 per cent, or from 199 to 230 per 1,000. In 1845, when better ac- 
commodations had been provided, the mortality was only 8^ per cent, or 85 per 
1,000; and subsequently, when "model barracks" had been erected, the number 
of deaths did not exceed 24 per cent, or 25 per 1,000;— clearly showing that the 
climate ot Hongkong: had nothing to do with the nppalling amount of rnortnlity. 



7G SHANGHAI HYGIENE. 

among them, what diseases prevail in the locality, and espe- 
cially what is the type of the diseases. I shall only very 
briefly touch on each of these points. 

1 Tempekatuee. What ought especially to be observed 
here, are the sudden changes, and range of temperature dur- 
ing the different months of the year. In Shanghai, for 
example, the temperature is tolerably uniform during the 
months of July and August, while in some other months the 
changes are sudden and the thermometric range is large. 
Thus this year, in the month of March, it ranged, during 
the day, from 41 to 70 degrees ; during the night, from 32 to 
53 degrees. In April, during the day it ranged from 54 to 76 
degrees, — one day it rose to 84 degrees, but suddenly fell to 
63 degrees; during the night, it ranged from 46 to 64 
degrees. 

The temperature of a locality will be much influenced, 
also, by the action of the sun upon the atmosphere, for it by 
no means follows that the feeling of heat is the same in two 
places, because the thermometric degrees are the same. In 
some localities, the thermometer will be 4 or 5 degrees more 
during the day than in the evening, and yet the evening is 
the only time that the heat is felt to be oppressive; this is 
owing to the free radiation and increased humidity which 
take place immediately after sunset, for at this time the 
atmospheie approaches nearer to the point of saturation, 
and consequently, much relief and comfort will be aiforded 
by closing the doors and windows just before sunset, before 
the relaxing damp air shall have entered. 

2. Humidity. The most accurate method of measuring 
the amount of moisture in the atmosphere, is by marking the 
difference between the temperature of the air and the tem- 
perature at which dew is deposited. Thus when both are 
widely different, the climate is dry; and when both are nearly 
the same, the climate is moist. Cceter is paribus, the amount 
of watery vapour in the atmosphere increases as we approach 
the equator, it is much influenced by circumstances which 
retard evaporation, and also by the fall of rain. 

Instruments made with a view to ascertain the amount of 
moisture in the air, seem only to measure the degree of eva^ 
poration. We may get a good general idea of the ana%iint 



SHANGHAI HYGIENE. 77 

of moisture in the air by its action upon inorganic bodies; 
as, where there is much moisture, iron and steel become 
oxidised very rapidly; and common salt speedily dissolves 
when exposed to the air. So it is also with organic bodies ; 
boots and shoes become mouldy; glue and paste soon loose 
their tenacious qualities; furniture falls to pieces, and wall 
paper is soon destroyed, while fermentation and putrefaction 
take place rapidly. The quantity of rain which falls should 
also be noted eveiy inonth and day, since in some latitudes 
as much rain will fall in three days, as will fall in others in 
a whole year, though more or less may fall every month. 

3. Geological Nature of the the Soil. This largely 
influences the qualities both of air and water, and modifies 
climate in a remarkable degree. For example, light coloured 
soils, lite this in Shanghai, during the summer months reflect 
a large amount of heat, while dark soils radiate and absorb 
heat. Clay and chalky soils are cool, as they long resist the 
solar rays; while ferruginous and carboniferous soils are 
heated rapidly, and also cool rapidly. Soils containing much 
salt impart to the atmosphere a feeling of freshness and 
coolness. 

4. Deainage and Cultivation. An unhealthy and 
dangerous locality may be improved to an almost incredible 
extent by artificial means. This has often been proved in 
nearly all parts of the world. Sir James R. Martin, in his 
excellent work on the "Influence of Tropical Climates," 
observes: — "In Calcutta, through the hitherto gradual im- 
provements in its ill-chosen site, intermittent fever has 
become, for many years past, a mild and infrequent disease 
comparatively. This simple fact strongly illustrates the 
beneficial influences resulting from local sanitary improve- 
ment, while it constitutes a powerful inducement, to the 
government and the public of the city in question, to proceed 
in the same course of amelioration, which has already secured 
to its inhabitants so great an exemption from disease." In 
another place, writing of Calcutta, he says: — "Strangers will 
read with surprise, that I do not think 1 saw above a dozen 
cases of ague in a year, on the average; and these occurred 
inpersons who went into the neigbouring jungles, on hog 
hunting and other such excursions." We do read this with' 



78 SHANGHAI HYGIENE. 

surprise, and delight too, especially when we place this side 
by side wiih Dr. Clark's records of Calcutta in 1770, when 
an epidemic of ague "with a cold stage of twelve hours," 
occurred, which carried off 80,000 natives and 1,500 Europe- 
ans. Captain Hamilton also states that, in Calcutta, out 
of 1,200 British inhabitants, 460 burials took place between 
August 1723 and January of the following year. Many 
other examples might be given, to prove the same great and 
important truth; and nowhere may the good results of sani- 
tary improvement be seen more strikingly than in England, 
where malignant ague, sweating sickness, dysentery, incura- 
ble scurvy, plague, &c., have nearly all disappeared. I 
believe that much, of the improvement of health, and the 
greatly reduced rate of mortality at home and abroad, are 
owing to the great advancement of medical science during 
the present century, and to the flood of light which has been 
thrown on physiology, pathology, the causes and consequently 
the cure of disease. No one however can doubt that diseases 
are now prevented, and their type changed and modified, by 
sanitary measures. Public health is, and ever will be, im- 
proved and preserved by proper drainage, cultivation, cleanly 
habits, and a well-regulated political and social state. I 
was*told the other day, by a merchant who has long been a 
resident in Shanghai, that in this "model settlement," during 
the last ten or twelve years, public health has improved in a 
surprising degree, and he rightly ascribed this change to 
sanitary improvements; this single fact should certainly ex- 
cite this community to still higher efforts to excel in all 
sanitary measures.* 

5. Proximity of Sea and Rivers. Maritime climates 

* May not the evident change and amelioration which have laken place in 
the climate of Europe be largely owing to cultivation and drainage'? CiEsar 
says, that "the vine could not be cultivated in Gaul on account of its winter 
cold ;" and the reindeer, now found only in the zone of Lapland, was then an 
inhabitant of the Pyrenees. In the reign of Augustus, the Tiber, and the Rhine 
were frozen over two or three months every winter, which now never happens. 
One cause of this, however, may be astronomical, namely on account of the apo- 
gee position of the earth's orbit being in the northern hemisphere during the 
Slimmer part of the year, or between the spring and autumnal equinoxes, thus 
the summer half of the year is now, according to astronomers, seven days longer 
than the winter half. Hence also the northern hemisphere is relatively hotter 
than the southern. 



SITANGHAI HYGIENE. 79 

are more uniform than those remote from the sea. In hot 
countries the neighbourhood of the sea is much more cool , 
and pleasant than districts inland. Where the country is 
flat and intersected with rivers, the tides, and the influence 
of the sea may be felt from 100 to 200 miles inland, espe- 
cially at the change of the monsoons; and generally, where- 
ver the influence of the sea extends, there the climate will be 
more or less equable, soft and humid. 

6. General and Local Elevation. For every hundred 
yards of altitude above the level of the sea temperature is 
diminished one degree, which is caused by the rarefaction 
which air acq[uires in its enlarged capacity. Consequently 
if we rear a structure 3,000 feet high, we may enjoy a tem- 
perature 10 degrees below that on the surface of the earth; 
and it is certain that we should also get above all malarious 
influence, as it has been ascertained that yellow fever, and 
plague, marsh remittent and intermittent, never ascend be- 
yond a certain altitude, while the limit of yellow fever, and 
plague, is very low indeed. 

7. Position OF Mountains. Mountains attract the watery 
vapours which are carried about by winds, and clouds and fogs 
are formed by these vapours becoming condensed. In some 
districts, these clouds and fogs are turned aside or stopped 
in their courses by a mountain or by chains of mountains; 
and currents of wind are also produced by them, while fre- 
quent showers of rain may be expected in their neighbourhood. 

8. Pkevalent Winds. The variations of the wind depend 
upon the equilibrium of the air, and nothing is more perni- 
cious than a stagnant atmosphere, especially in a locality 
where noxious effluvia and concentrated malaria constantly 
emanate from the earth's surface. Even quadrupeds, insects, 
and plants are greatly influenced by prevailing winds. 
Winds, coming from off mountains, continents, and large 
tracts of land, are always colder and sharper than off the 
sea; monsoons always change soon after the equinoxes, and 
always blow towards the hemisphere where the sun is; so 
that in many places, the wind will come from off the land 
one half the year, and from off the sea the other, unless it is 
influenced by highlands, or diverted by chains of mountains. 
In whatever region of country the influence of the sun is 



80 SHANGHAI HYGIENE. 

most felt, thither the wind will direct Its course, because 
there the solar heat has dissipated and dilated the atmosphere. 

9. General amd Local Aspects. The climate of a local- 
ity is much influenced by the relative exposure of the soil to 
the sun. The general aspect of a country may be the reverse 
of its local aspect. As a general rule, in the northern hemi- 
sphere, north-east aspects are cold, and south-west and south- 
south-west aspects are warmest. 

10. Trees and Vegetation. Trees tend much to reduce 
temperature; they also powerfully attract marsh malaria, so 
that if trees are placed between a marsh and a residence, its 
inmates will be secured against the marshy exhalations. 
Moreover, it has been proved that a locality covered with 
trees emits one-third more vapour than one covered with 
water, and all vegetation according to its density will have 
the same effect. There is. no better way of improving a 
locality where the trees and brushwood are too dense or close, 
than by clearing most of th6se away, only leaving, at certain 
distances from each other, long belts and clumps which will 
contribute much both to health and beauty. 

With regard to atmospheric pressure, other circumstances 
being equal, the relative quantity of oxygen in a given space 
is considerably greater at a pressure of 31 than at 28 inches ; 
and hence it will be readily understood why, in thick, humid 
weather, people experience a certain amount of lassitude and 
languor, and not the buoyancy of feeling peculiar in clear dry 
states of the atmosphere. It is also worthy of notice, and 
shows that the variations of atmospheric pressure greatly in- 
fluence man, that paralytic and apoplectic cases are most 
frequent during rapid changes of the barometer, especially 
when its level is suddenly depressed; and minor affections of 
the head, such as shooting pains, vertigo, oppression, &c, are 
also more frequent. 

I cannot but think that a climate is considerably modified 
by different states of electric tension, although some autho- 
rities assert the contrary. We know, that electric equilibrium 
is considerably altered by change of temperature, that every 
chemical action produces electric change, and that decom- 
position of surface water and all evaporation do the same. 
Even the spray of a waterfall sensibly alters the balance of 



SHANCfHAI HYGIENE. gl 

the electrometer placed near it. The rising and falling of the 
tides, as well as the amount of moisture in the air, cause 
the amount of electricity to fluctuate. The amount of at- 
mospheric electricity is greatest for a few hours after sunset, 
and least before sunrise and sunset. Marshes produce effects 
upon the animal economy very analogous to those produced 
by the galvanic pile; and this injurious action is increased 
by certain proportions of water, especially if the water holds 
in solution any organic substances. The drying up of a 
marsh is very similar, in many respects, to a galvanic pile 
deprived of humidity. 

A peculiar and special action is produced on the nervous 
system by the electric machine, very similar to that produced 
after exposure to a marshy atmosphere, where malaria exists. 
Here is a most interesting field for investigation.* 

If we attach an animal to the opposite pole of a galvanic 
battery, and thus deprive it of its positive electricity it will 
soon pine away and die; and I think there can be little 
doubt that, if the human body is exposed to an atmosphere 
with a negative electricity, it will very soon be deprived of 
its power of resisting the many causes of disease which sur- 
round it. I am also convin,ced that human health is much 
influenced by the ever vatying states and degrees of the 
earth's magnetism to which it is always exposed. 

Here is the place to offer a few words on the production 
of malaria and the laws by which it is regulated. Although 
we can determine, with the greatest accuracy, the various 
constituents of the atmosphere, and by the nicest shades of 

* I am' strongly inclined to believe that electricity in a modified state is the 
agent which influences and regulates to a great extent the various secretions of 
the body through the sympathetic or organic system of nerves; and hence the 
various proportions of the amount of electricity in the atmosphere, in certain 
localities at different seasons of the year ; have a considerable influence on the 
health of the animal economy, more especially on persons whose nervous system 
has been rendered susceptible by ofl;en repeated changes; as those who have been 
several years in a warm or hot climate always suffer more or less on removing 
to a colder one ; and even those long exposed .to the Shanghai climate suffer in 
the early part of summer until the warm weather sets in; thi^ feeling I think, is 
greatly owing to the low electric condition of the cold atmosphere, or the small 
amount present being in a negatve condition, the body is deprived of its positive 
electricity and a feeling of listless irritability and sinking is the result. The 
same also takes place at the close of the hot seasons, when the body is Ipss able 
lb resist the existing causes of dicease. 



82 SHANGHAI HYGIENE 

chemical analysis ascertain the relative proportions of each 
permanent gas, and also certain subtle substances found only 
occasionally and under certain circumstances, as ozone, 
iodine, free cMorine, nitric acid, &c. ; yet hitherto no chemi- 
cal analysis has detected a single trace of marsh malaria; 
still, "when we consider the great advances which are con- 
stantly being made in chemical science, we need not despair 
of this being done. In such an investigation, however, 
perhaps as much may be expected from the microscope, as 
from chemical analysis. 

All previously organized matter, in a certain stage or mode 
of decomposition, is largely concerned in the evolution of 
malaria, especially under a certain temperature and within 
certain limits; also various kinds and various degrees of this 
poison will be evolved: one form will produce plague; an- 
other, yellov fever; a third, low continued fever; a fourth, 
remittent; a fifth, intermittent: and these too in all their 
various types and degrees of intensity. Moreover, the soil 
of a locality has much to do in this production of malaria. 
Contrary to general belief, certain sandy soils produce fevers 
of a more aggravated nature than the swamp. This is proved 
in a very striking manner in tljp Alentejo and Algarve of 
Portugal, regions, which are never free from fever, and yet 
the soil is abnost entirely composed of sand. In India the 
most fatal and intractable forms of fever have occurred in 
localities where the soil was ferruginous, and among hiUs 
principally composed of granite, but containing also mica, 
felspar, quartz, and highly magnetic disintegrating ferrugin- 
ous hornblende, and this last in very large quantity 

Beds and banks of rivers containing ferruginous clay and 
red sandstone are said to be much infested with malaria. 
Soils though black may contain much iron mixed with 
decomposing organic matter. Yet in order to render ferrug- 
inous and sandy soils thus dangerous, I believe that a certain 
high degree of solar heat, humidity, &c., are necessary in 
certain localities. It also prevails in a greater or less degree 
in deep rich alluvial soil, with much vegetable mould. The 
action of the sun upon all stagnant moisture near the level 
of the sea seems to favour the production of malaria, 
and yet it appears that a certain degree of heat is only 



SHANGHAI HYGIENE 83 

capable of producing it when combined with a certain amount 
of moisture, sinc% a very dry season may render a marsh or 
swamp quite harmless, and it is always much less dangerous 
to traverse a marsh during the day than at night. Excess 
of moisture also checks its development, as in very wet 
seasons marshes are less unhealthy. Malaria has never 
been known to be developed in ships in latitudes north of 48 
degrees. 

It seems heavier than air, for people who occupy ground 
floors are oftener affected than those who live in upper apart- 
ments. Good fires in a house seem to destroy its power. 
Trees attract it powerfully, so that to sit or sleep imder a 
tree in a marshy district, is to meet it in all its concentrated 
intensity. Peat bogs, however swampy are not malarious, 
being free from decomposition and effluvia of every hurtful 
kind. 

I need scarcely say that the constitution of some indivi- 
duals has greater power to resist the injurious influences of 
the various forms of malaria than that of others. Much also 
depends on the habits of an individual, the degree of health 
and vigour enjoyed. A healthy man may be quite free 
from ague until he 'gets a cold; or becomes debilitated; or 
exposes himself to malarious influence at night or early in 
the morning, with an empty stomach; in all which conditions 
an ague may commence, modified however according to in- 
dividual peculiarity. 

For example, four people being exposed to cold, _ one gets 
bronchitis; another, sore throat; the third, a diarrhoea; 
while the fourth escapes entirely: all four were equally ex- 
posed to the same cold; three were predisposed to disease, 
though each in a different way; but the fourth was not, and 
therefore the exciting cause produced no effect. And so it 
is, in short, with all other diseases. 

During the decomposing process of water in a marsh, little 
or no oxygen can be detected, although it is found in its usual 
proportion in the neighbourhood of the marsh. And as oxy- 
gen is emitted in considerable quantities from all other sur- 
face waters, and during its emission ozone is formed, it fol- 
lows in theory, as it is found in fact, that no ozone is formed 
in or over a marsh. In surface water, free from decomposition 



84 SHANGHAI HYGIENE 

find abounding with infusoria, a rich supply of pure oxygen 
is emitted; say two cubic inches of oxyge^i for every square 
foot of surface water; and as there is a larger amount of watery 
vapour in the atmosphere in summer than in winter, equal 
volumes of air will contain less oxygen in summer than in 
winter; and as ozone, whose presence for some time has been 
and is stiU considered so essential in order to constitute a 
healthy atmosphere, is increased or diminished in quantity ac- 
cording to the relative amount of oxygen, the health of a 
locality might be ascertained in this respect by testing the 
atmosphere for ozone, The latest investigations declare 
ozone to be a teroxide of hydrogen, and its chemical formula 
would be HO3. Some have named it electrified oxygen. It 
is produced by the action of phosphorus on the surface of 
water. 

Paper impregnated with starch and iodide of potassium 
makes a good ozonometer, being rendered S fee by ozone, faint 
or deep according to the amount in the atmosphere. The air 
of no locality can be considered unwholesome which contains 
ozone. Various gases, especially those spontaneously depelop- 
ed, prevent the formation of ozone, or destroy it when 
formed; and all these gases are also injurious to man, and the 
other higher animals; such as carburetted, sulphuretted, and 
phosphoretted hydrogen, with similar emanations. It cannot 
be detected in the atmosphere during the prevalance of epide- 
mics, such as cholera, low fevers, ague, &c. In Shanghai, 
except when the wind is from the west or north-west, traces 
of it can always be found; but when the weather is warm and 
the air approaches the point of saturation, scarcely a trace 
can be discovered. During the months of July and August, 
1860, I failed to detect it, except immediately after a thun- 
derstorm when the air was purified and tolerably cool. It is 
always present in the atmosphere at sea, and in seaport towns 
when the wind is off the sea. 

In a country like China, — larger than the whole of Europe 
and necessarily containing almost every variety of climate, 
though that of each locality is comparatively very little 
known — probably one of the methods of obtaning a know — 
ledge of the climate of each difierent locality, would be to 
institute a series of comparisons. By this method the climate 



SHANGHAI HYGIENE. 85 

of any one given locality in China miglit be compared with 
that of well-known localities in Europe, which are found to 
be decidedly bsne'ficial to different classes of invalids, and 
to the same invalids in incipient or advanced stages of ihe 
same disease. 

For ey/^mple, the climate of Shanghai might, in many 
respecis. be compared to that of the south-west of France,, 
which is humid, soft, and relaxing; and were drainage, culti- 
vation, and sanitary science equally attended to in both places, 
the analogy would no doubt be much closer. The south-west 
coast of England also is of .the same character, soft and hu- 
mid, though differing much in degree. Pulmonary diseases, 
dry irritating coughs, gastric dyspepsia, certain kinds of 
headache, &c., will be benefitted by this sort of climate; while 
to persons of relaxed habits of body, with languid circulation, 
deficiency of nervous tone and energy, especially with debility 
of the digestive organ-:, and a tendency to irritation or disease, 
of the mucous membranes, such a climate will prove decidedly 
unfavourable. 

From the little I have heard of Chefu, its climate, with 
certain modifications, might be compared in many respects 
to that of the south coast of England, which is bracing dry 
and elastic, especially in Brighton and Undercliff. Debili- 
tated habits of body and deficiency of nervous tone and ener- 
gy wiU benefitted by such a climate. Perhaps a closer analogy 
might be found between Ohefu and New York. Ohefu promises 
well to be the best sanatarium in the north of China; and were 
foreign houses erected, and means of amusementprovidedfo.r 
invalids, and for those who want change or bracing air for a 
few weeks, Chefu would prove an excellent resort, and almost 
an antidote to the relaxing moist climate of Shanghai. 

In some respects the the climate of Tientsin might be 
compared to that of the Crimea. The range of tempera,ture 
is oreat and very sudden in both, with intense frost in winter 
and great heat in summer, In many particulars, however, 
the analogy will cease, as in one the soil is alluvial and the 
neighbourhood flat, whUe in the other it is rocky and moun- 
tainous. The climate of Tientsin will be much deteriorated 
by the never-ceasing annoyance of those so called showers of 
sand which foreigners declare intolerable, but who have as 



86 SHANGHAI HYGIENE. 

yet thrown very little light on their origin or nature. 

At present I do not know any locality in China whose 
climate could be compared with that of Naples, which ia 
exciting, exhilarating and warm ; perhaps that of Nagasaki 
might approach nearer to it than any other which we know 
as yet; but we want much more information in regard to the 
climate in all the various localities of both China and Japan. 

Amoy on some accounts might be compared to Maltaj 
though considerably hotter. I fear there is no climate to be 
found either in China or Japan, which can be compared to 
that of Maderia, or the Azores. With its cool summers and 
mild winters, together with its equable temperature through- 
out the whole year, the climate of Madeira is declared by 
the highest authorities to be the finest in the northern hemi- 
sphere. 

It seems not at all unlikely that the climate of Hankow 
will, in many respects, be found to resemble that of Kome, 
which is mild, soft, and, owing to its singular stillness of at- 
mosphere, is rather oppressive and relaxing; yet. Sir James 
Clark considers it one of the finest climates in Italy. Such 
a climate, however, should be avoided by persons of a me- 
lancholic or nervous temperament, also by those predisposed 
to apoplexy and paralytic affections. 

It has often been observed that in localities where ague 
prevails, cases of consumption are exceedingly rare. Now it 
seems to me that ague and phthisis are essentially antago- 
nistic; and I cannot conceive any man who has an intimate 
knowledge of the various organs involved in these diseases, 
with their different functions, coming to any other conclusion 
in theory; sjadi facts, I believe, will abundantly prove the cor- 
rectness of this theory. In and around Shanghai, for exam- 
ple, where ague in a modified form is very common, from 
the middle of April 1860 till the end of Julyl861, among up- 
wards of 28,000 cases which came under my own observation, 
only ten were of pulmonary phthisis; and even of these ten, 
only seven were well marked, while there were more than 
1,400 cases of intermittent fever. Tubercle is common, but 
is almost entirely confined to the abdominal organs.* 

* In the summer of 18B 1 , a Gentleman newly arrived from New York consulted 
me regarding his health and the Shanghai, climate. He stated that in New York 



SHANGHAI HYGIENE. 87 

During the sudden changes of tem^jerature, which at certain 
seasons occur in Shanghai, bronchial catarrh is exceedingly 
common; and in elderly people passes into a chronic state; 
and in almost every respect simulates consumption, and will 
pass foi this disease, unless the chest is carefully examined, 
when the disease is found entirely confined to the bronchial 
tubes, the lungs being perfectly soimd. . The climate of Shang- 
hai is esentially humid; and, during the hot mouths of July 
and August, the atmosphere approaches close to and often 
reaches the point of saturation; the air is much rarified, and 
contains less oxygen in a given bulk, than when it is cold 
and dry, while respiration is shallow and more slowly per- 
formed. Thus the blood is less perfectly oxydised and 
contains too little oxygen to stimulate the heart, blood ves- 
sels and nerves, and the individual is predisposed to low 
types and forms of disease of a periodic character. 

During the hot months also, the hygrometric state of the 
atmosphere is such, on certain days after heavy rains in 
Shanghai, that instead of watery vapour being exhaled from 
the lungs at the rate of one ounce per hour, as in tolerably 
dry states of the atmosphere, I am sti-ongiy inclined to be- 
lieve that pulmonary exhalation is all but arrested, and the 
function of the lungs is reversed, having assumed for a time 
the function of absorption. Fluid passes off by the skin in 
two ways, namely,, by evaporation, which is essentially a 
physical process, and also in the form of perspiration, a vital 
process of transudation; now, when the air is saturated with 
fluid and its temperature equal to that of the body, the vital 
process of transudation only will be carried on, the physical 
process of insensible evaporation having for a time ceased; 
the above conditions however are not common, and can only 
take place when the temperature of the air is equal to that 
of the body, and saturated with vapour. Under any circum- 
stances, however, free evaporation from the body will be 
impeded, or modified, according to the amount of moisture 

he had suffered considerably from Chest affection, and that the physicians urged 
hun to take a sea voyage. At the time I examined him he had considerable 
cough, and pain in one part of the chest. I expressed a belief that this climat e 
would suit his case; and advised him to remain. He did so, and has enjoyed good 
health, the cough and pain gradually Ceased; and at present he looks much better 
than he did when he arrived. 



88 .SHANGHAI HYGIENE. 

in the air and so ivill tlie feeling of languor and oppression 
be greater or less according to the state of the atmosphere, 
whether it is still or in free motion; and hence the advantage 
and utility of punkas, and thorough draughts, as thes^ 
change rai)idly the particles of hot moist air, which retard 
evaporation, if left to remain in contact with the skin; true, 
the system under tlicse circumstances will relieve itself 
greatly by the process of free perspiration, but this req[uires 
more or less eflbrt which might be avoided by making the 
surrounding air circulate freely by artificial means; prickly 
heat (lichen tropicus) will also be prevented, and altogether 
the system will suffer less from exhaustion, by the perspira- 
tion being kept within bounds. 

During the colcl months in Shanghai, which are more 
numerous than the hot, the air still continues moist, and 
often approaches and reaches the point of saturation, and 
the efl'ect upon the body is very similar to that of dry air at 
a high temperature, except that here great demands are made 
on the body by the very active exhalation taking place from 
the lungs, vital heat being abstracted every moment in order 
to raise the temperature of the cold moist air inhaled to that 
of the body. The cold damp condition of the air also favours 
cutaneous evaporation, but the vital action of transudation 
is checked, and if perspiration is induced by vigorous exer- 
cise &c., it is apt to remain on the surface, causing chills 
and deranging the balance of circulation. In the climate of 
Shanghai the state of the body with its circulating, fluids is 
in the cold months entirely opposite to what it is in the 
hot; but as changes are only injurious when sudden and 
great, with proper care and attention during transition, no 
harm need be feared. 

Early in September the nights become cool, the range of 
temperature increases, the \isual flow of blood to the surface 
of the body is checked during the chilly evenings, and all the 
fluids are driven back upon the internal organs, especially 
"upon the liver, spleen and bowels, which in their comparatively 
enfeebled state are unable to bear the pressure thirs sudden- 
ly put upon them, and the balance of circulation being 
deranged, intermittent fever or dirrhoea results according to 
the predisposition of the individual. 



SHANGHAI HYGIENE. 89 

But with a tolerably good constitution; temperance in all 
things; strictly avoiding the cheap Chinese fruit, which may 
be seen in such profusion in all the streets, everywhere looking 
so tempting to the parched palate; and also taking care to 
provide against the changes of temperature, which supervene 
suddenly during the autumn; with these precautions, there 
is no reason to fear the climate of Shanghai. 

In closing this article, I may remark that the climate of 
Shanghai, or rather that of the foreign settlement, — may be 
improved to almost any extent by artificial means, if judi- 
ciously adopted and vigorously carried into operation. Already 
much has been done; some of its houses, one might almost 
gall them palaces, have been built on the best, pi-inciples 
for health, elegance, and accommodation; but its system 
drainage is very incomplete and notwell regulated. If 
this matter be not attended to, and if the Chinese, already 
so numerous, with their extraordinary no- tions of sanitary 
measures, still be allowed to build all manner of houses 
in such close proximity all round aboutand among our 
residences, both the health and the comfort of the foreign 
community must suffer; and ere long, instead of the 
desired improvements, we shall have to witness dete- 
rioration, with nuisances and diseases hitherto unknown in 
this settlement. Surely, it ought not so to be; and there 
will be no excuse for it, if the case be allowed to reach such 
an unseemly condition. There is no necessity for encroach- 
ments, such as have been m^de here of late. There is ample 
space, westward and northward, beyond our precincts, for 
all building purposes. But the danger is, and it is imminent, 
that the introduction of the proper sanatory measures will be. 
delayed too long, and only come when it will be too late to 
secure all the desired improvements. 

This prediction thrown out more than two years ago has 
been realized to the letter, houses and streets, new towns and 
villages have sprung up around the Foreign settlement. The 
Shangha? population has been more than doubled; crowds 
of people from all quarters have sought a refuge here, and 
the usual results have attended this state of things — more 
disease and death comparatively, more filth, more fever, and 
more crime. And had it not been for the constant vigilance 



90 SnANGUAI HYGIENE. 

and energy of the municipal authorities, matters would have 
been much worse than they now are. Recently I applied to 
a gentleman whom it will be admitted is well qualified to 
form an estimate of the Native population of Shanghai. 
Mr. Yates counted the Chinese houses between the Yang- 
King-Pang, and the Soochow Creek; and his intimate 
knowledge of the Chinese enabled him to form an accurate 
estimate of the number contained in each house, and in each 
family; and he believes there are as nearly as possible, eight- 
een hundred thousand people in, and around the city of 
Shanghai. Here then we have a population equal to that 
of London twenty years ago; and considering the inefficiency, 
nay, the proverbial imbecility (except for mischief) of the 
Chinese Authorities, socially and politically; too mucfi. 
praise cannot be given to H. B. M's Consul, and our Muni- 
cipal Council, for the admirable arrangements which they 
have made to meet the growing difficulties; and the capacity 
and versatility, which they have shewn to be equal to any 
emergency. 

The chief objects of governments in all countries and com- 
munities, are, or ought to be, the protection of life, health, 
and property, of the population; from foreign aggression, and 
the observance and advancement of religion and morals: for 
these purposes laws are enacted and enforced. Unfortunately 
the health, and consequently the lives of the inhabitants have 
occupied the smallest share of the attention of governments, 
legislators, political economists,- and municipal authorities in 
most countries ; and Shanghai has proved no exception to this 
rule. Our authorities have done much, but no one knows 
better than they do themselves, that much remains to be 
done. The health and welfare of hundreds and thousands of 
people depend upon the acts of our Municipal Council. 

They have however much to contend with; they meet with 
much opposition in the discharge of their duties. The acts 
of companies and individuals, tend to thwart and evade the 
necessary laws and wholesome regulations of these authorities. 
The multifarious modes in which avarice, ignorance, low 
cunning, and the love of oven-eaching, are practised both by 
natives and a certain class of foreigners, sap directly and in- 
directly the springs of' health and life, and often frustrate 



SHANGHAI HYGIENE. 91 

the best intentions of those at the helm of affairs. Thanks 
to the lavTs of ourjocal authorities, the time has gone by, 
when any money loving speculator can run up houses of any 
description, as dens of disease and death ; and construct streets 
like cess-pools according to his avaricious fancy; but by and 
bye we shall see, that there are men still who if they are not 
permitted to speculate in such unwholesome edifices, within 
the jurisdiction of municipal law, will do so without that 
jurisdiction; and make money out of the health and lives of 
their countrymen, under the garb of a nobler plea. 

Houses, Streets, and Villages sprung up much faster than 
drainage and other sanatory measures could be carried out; 
and the hot weather last year brought with it, low fevers, 
dysentery, diarrhoea and some oases of cholera. The con- 
struction of drains, the making and mending of roads is slow 
and tedious work here. Nevertheless the municipal autho- 
rities began this good work, and have carried it on with 
considerable energy, and their perseverance wiU be rewarded 
by seeing the health of the community increase year after 
year as their sanatory measures progress; life and health 
will be more secure and property will be more permanently 
enhanced in value. A good system of drainage and well 
made roads, will as surely improve the health of the Shang- 
hai community as effect follows cause. Malignant diseases of 
every kind have been banished from Calcutta by artificial 
means; we never hear now of terrible epidemics "which 
sweep off 800 Europeans and 50,000 Natives within a few 
weeks" as formerly. The cause of this is obvious to the. 
most ordinary understanding. 

The same observation applies to London. The filthy 
state of London was notorious during the 73 years between 
1592, and 1666. The consequence was, that the average 
deaths of each year /rom the plagues, amounted to one fourth 
of the whole population!, or what in the present population 
would amount to the fearful mortality of 600,000 persons. 
Sanatory science however, during the present century, has 
reduced the mortality to 1 in 250, or little more than 6000 
in the worst years of cholera, the most severe plague that has 
visited London since 1666. The same holds good in regard 
to Liverpool, Manchester, Paris, and other large erties. 



92 SHANGHAI HYGIENE. 

When places are neglected and filth allowed to accumulate, 
water to stagnate, and exuviee to rot, diseases must multiply 
and deaths will increase ; and hence the well known observa- 
tion of Cabanis still true in our time, "I'effect du climat 
n'est pas le meme pour le riche que pour le pauvi-e" ? I 
shall here give Dr. Copland's rules which demand the serious 
attention of all classes, especially of those connected with 
Municipal work. 

"All sanatory measures which should be enforced in a lo- 
cality should have for their objects — 1st, The removal of the 
excretions, as speedily as possible, from the dwellings of the 
people, and the prevention of their accumulation; — 2nd, The 
means or method of their removal should be such as should, 
as efficiently as possible, prevent the escape of the gaseous 
and putrid emanations they emit into the atmosphere; — 3rd, 
That a sufficient supply of water should be provided for the 
rapid removal of putrid exuviee and excretions, and for other 
purposes of cleanliness and ablution; — 4th, That animal re- 
mains and excretions should as quickly as possible be conve- 
yed to their natural and intended destination namely, to 
cultivate fields and soils, with the intention of fertilizing 
them; — 5tli, That the bodies of the dead should not become 
from the mode of sepulture, and the situation and crowded 
state' of the places of burial, with reference to the habitations, 
especially in cities and towns, a source of disease to the liv- 
ing; — 6th, That ditches and marshes should be removed, 
especially in the vicinity of animal and human habitations, by 
underdraining &c, ; — 7th, That whilst the supply of water 
should be abundant, it should in no way be contaminated by 
the vicinity of burial-grounds, ditches, or marshes; — 8th, 
The supply of pure air, and the requisite renewal of it in all 
circumstances, with little risk of contamination from aniraal 
excretions or remains, from drains, sewers, cesspools, church 
yards, ditches, marshes, &c. In proportion as attention is 
paid to these topics, so will the health of cities and towns "be 
improved. It is almost unnecessary for me to insist upon the 
impro2mety of allowing ditches, sivamps, or marshes to con- 
taminate the air in the vicinity of ■ towns, or any human 
habitation whatever; or to bring supplies of water from places 
near to these sources of disease, or to burying grounds. 



SHANGHAI HYGIENE. 93 

Water loaded with animal matters in a state of decay, or 
abounding with animalculfe, and the infusoria, is most 
remarkably productive of diarrhoea, dysentery, mucous and 
adynamic fevers, or of those typhoid forms of fever which 
are attended by ulceration of' Petee's and Brunner's 
glands. _ The means of removing these causes are too obvious 
to require notice at this place; and ought never to be ne- 
glected, although no very manifest mischief may result from 
them, or no very remarkable outbreak of disease may occur. 
They nevertheless impair the constitutional powers of all 
within the sphere of their influence; induce, gradually 
and slowly, visceral obstruction, and numerous chronic 
maladies, and favour the pi-evalence by promoting the 
infection of malignant and pestilential distempers." 

Last season it will be remembered, the greatest amount 
of mortality occurred among soldiers and sailors, the reason is 
obvious, especially in regard to the latter. The soldiers who 
suffered most, were quarteredinlowfloored, damp, mouldy Go- 
downs, without ventilation, and bad light; houses in which a 
merchant would not riskhis horse ; as a proof that the accommod- 
ation was more to blame than the climate and season, we have 
only to look at the case of the Officers, who being quartered 
in good houses did not suffer. In the case of Sailors, the 
cause of disease seems patent enough. Of all places through- 
out the whole Eastern world, rivers, and especially the mud- 
dy rivers of China have through all past experience and 
observation, proved the active foci, and the most prolific 
sources of malignant and unmanageable forms of disease. So 
numerous are the authorities who mention muddy rivers as 
sources of cholera, dysentery, diarrhoea, remittent and inter- 
mittent fevers, that I can only mention a few of them. I 
presume however that few disinterested people, will dispute 
the unhealthy influence during the hot season of a dirty 
river, like the one so near us here; and into which are 
elnptied aU the offal and debris, of nearly two millions of 
people, within the short distance of two or three miles. 

Dr. Bryson in his Statistical Beports on the health of the 
Navy for the years 1837 — 43 inclusive, gives fearful accounts 
of the amount and malignancy of diseases contracted by sold- 
iers and sailors on the Chinese Elvers. Cholera dysentery, 



94 SHANGHAI HYGIENE. 

remittent, intermittent, and typhoid fevers, with phage- 
deenic sores and sloughing ulcers, were the prevailing diseases. 
"Fevers," he says,' "were more tii;i, i irebled, both in amount 
and mortality by the Chinese war, and were contracted 
chiefly in the Canton, and Yang-tse-kiang rivers." "In 
1842, "the disease was confined chiefly to the ships at Chiang 
Kiang-Foo — Woosung, and Nanking. In every vessel em- 
ployed in the Yang-tse-kiang, from Woosung to Nanking, 
between the middle of July and the middle of October, 
Cholera, or choleraic diarrhoea broke out, while not a case of 
either form of the disease appeared in vessels employed on 
other parts of this division of the station, with the exception 
of those which arrived at Chusan from the Yang-tse-kiang." 
(P.59). 

In the Beport on diseases among ike Troops by Geo. 
Clerihew m.d. staff surgeon 1st. class, I read, "The presence 
of water seemed every where to increase in a marked manner, 
the prevalence of the disease. It thus appears that the 
presence of water, whatever way it operates, has a marked 
eifect in increasing the prevalence of Cholera." 

Much information of this kind is also given in Medical 
Notes on China hy John Wilson m.d. "Inspector of Naval 
Hospitals and Fleets, London, 1846." — The crew of the ship 
in which I first came to Shanghai were remarkably healthy 
during the voyage, but before they were a week on this 
river, three or four men were laid up with ague and dian'- 
hoea. 

Last Summer I came to Shanghai in a steamer round the 
Cape. During the voyage, the 37 people on board had enjoyed 
perfect health, but ten days after our arrival here, one had 
died, three or four had diarrhoea, and the Captain, who had 
not been sick for 18 years, was seized with a very serious 
attack of Shanghai fever. But why multiply instances of the 
dangerous andinjurious influence which this river has on ship's 
crews. ? Some time ago I was told by a Surgeon, who has 
had the largest practice among the shipping here for several 
years, that the only thing which deterred him from having a 
floating Hospital, was his knowledge of the unhealthiness of 
"the river, and his flrm conviction that the mortality on board 
such an Hospital, where men are placed in close proximity 



SHANGHAI HYGIENE. 93 

would be immense. The great mortality among the shipping 
last season was evident to all. In the Shanghai Becorder 
of May 14th, I read, "During the cholera epidemic of last 
summer, there were we believe no fatal cases on the Hong- 
que side, between Howard's and Heard's jetties. Yet on the 
river, not a stone's throw from these houses every ship had at 
least one dead. The average was, we are informed, much 
higher, but no ship entirely escaped. Some reason must be 
given for this circumstance. That which suggests itself to 
us is, that the poison is carried along with the stream of air 
which necessarily follows the course of a rapid river. It is 
impossible to say where the poison is generated, but it seems 
most probable, that the low and marshy lands through which 
the river passes, at least contribute their share to the death 
bearing current. It has also been noticed by surgeons prac- 
tising in India, that the shipping on the rivers always sujBfers 
more from Cholera epidemic than do the dwellers on dry land. 
This cannot arise from ill ventilation, for in summer all the 
ports are left open even at night, and the majority of the 
crew sleep on deck. As far then as j;he health of the large 
floating population on the river is concerned, we should im- 
agine, that if possible, the majority of the men should be 
removed on shore, and only a sufficient number of Europeans 
left on board to keep the necessary watches. The men could 
day after day be changed, and thus the same sailor need never 
stay for two consecutive nights on board ship." 

It would be difficult to carry out this last suggestion ; but 
it would be both easy and eminently practical to construct a 
large, well ventilated, and commodious Hospital for sailors 
on shore. Were a weU arranged Hospital of this sort ei-ected 
for the merchant service here, the great mortality during the 
hot season, I can confidently say, would cease among the sea- 
men. Instead of this what have we ? Hitherto nothing, * 
for the reason above stated. The humane surgeons practising 
among the shipping, declined to construct floating Hospitals, 
which in all parts of the East had always produced an ap- 
palling mortality — Even in pure sea water. Hospital ships 

* One or two Hospitals have beeu carried on by medical men here; but not 
to such an extent' as to meet the necessities of the shipping. 



96 SHANGHAI HYGIEKE 

have given a much higher mortality than Hospitals on shore. 
Much more on a malarious muddy river. Two causes pro- 
duce this; 1st, a want of cubic s])ace for each bed, lovf roofed 
wards and bad ventilation; and, 2nd, the j)ernicious influence 
of the dirty river. Let any one examine the "Papers on the 
sanitary condition of Hospitals," or the "Evidence given by 
Miss Nightingale before the Koyal Commission on the sanitary 
condition of the army," before they advocate Floating Hos- 
pitals, or low roofed crowded wards. This evidence shows, 
that the amount of mortality in the wards of an Hospital, 
bears an exact ratio to the number of sick j^ersons in each 
ward. — That ventilation will always be bad when there is a 
deficiency of cubic feet, and when cubic feet, or ventilation 
is defioient, disease will be induced among healthyindividuals. 
How then can the sick reco vpt under such circumstances.^ 
And yet the sick are placed in such Hospitals, by those who 
ought to Jcnoip better; and when the unfortunate patient dies, 
blame forsooth is put on the climate, or on the type of the 
disease; and another poor patient is admitted, put into the 
same bed, subjected to the same pernicious influences, and as a 
matter of course makes his exit from the ward by the same short 
road. And so the admissions of the living, and the departures 
of the dead go on ad-infitiitum, or as long as a sick man re- 
mains to be admitted; while the public instead of having 
matters investigated, marvel at the amount of mortality. 
In an article headed Cholera in its relation to sanitary 
measures, in the British and Foreign Medical Bevieio, for 
January 1851, 1 I'ead, "If we take the ordinary computation 
of 20 cubic inches of air being drawn into the lungs at each 
inspiration, and of there being about 20 respirations in a 
minute, then 333 cubic feet or 33 hogsheads, are made use 
of by each person per diem. Not less than between 10 and 12 
cubic feet of carbonic acid, are therefore evolved in the course 
of the twenty four hours, a quantity which will be found to 
contain at least six ounces of solid carbon ! The considera- 
tion of this fact alone must suffice to shew the extreme im- 
portance of there being no impediment to . the due exercise 
of the respiratory function, and prepares us at once for the 
pernicious results that inevitably attend upon the breathing 
of an atmosphere, which does not enable the system to remove 



SHANGHAI HYGIENE. 97 

its_ self generated poison."* Referring to the ventilation of 
ships, the same article says, "this can never be adequately 
eifected, by open hatches, windsails or ventilating tubes, and 
that it is only with the aid of moving potver — as for example 
one of Dr. Arnott's air pumps, that it can be properly done. 
Active not merely passive ventilation is required wherever 
numbers are congregated in a limited space." The evidence 
given before the Eoyal Commission declares, that "Each 
hospital bed should have a territory to itself of 8 feet wide 
by 12 feet long". "That every hospital ward should be at 
at least 16 feet high." "That it is not possible to ventilate 
sufficiently a ward 10 or 12 feet. high." "That unless the air 
within the ward can be kept as fresh as the air without, the 
patients had better be away." "Thatawardto contain 20 beds, 
should not be less than 80 feet long, 25 feet wide,and 16 feet 
high." "That each bed should never have less than 1,500 
cubic feet of air, and if possible 2,000." "That low roofed 
wards with ceUs communicating with each other by corridors, 
are pestilential, and certain death to the patients". One 
might have thought that such evidence would have dealt the 
deathblow to 'Floating Hospitals; for what such hospital 
has wards 16 feet high.? Or what bed has a territory of 8 
feet by 12.? Or what ward 80 feet by 25 has only 20 beds? 
Therefore it is absurd to construct such hospitals for the sick, 
and suppose they will recover. Miss Nigh tingalfe says, "To 
place patients in low roofed crowded wards, is nothing but 
manslaughter under the garb of medical treatment; or simply 
to kill them with the addition of torture." In the low roofed 
crowded wards of Scutari, 2 men in every 5 died, 40 per 

•"* Every adult exhales by the langs and skin forty eight ounces, or three pints 
of water in twenty four hours. Sixteen men in a room would therefore, exhale 
in eight hours sixteen pints of water, and 1'23 cubic feet of carbonic acid into the 
atmosphere of the room. With the watery vapour, there is also exhaled a large 
quantity of organic matter ready to enter into the putrifactive condition. This 
is especially the case during the hours of sleep; and as it is a vital law that all 
excretions are injurious to health if reintroduced into the system, it is easy to 
understand how the breathing of damp foul air of this kind, and the consequent 
re-introduction of excrementitious matter into the blood, through the functiou of 
respiration will tend to produce disease. 

If this be so for the well, how much more will it be so for the sickl for the sick, 
the exhalations from whom are always highly morbid and dangerous, as they are 
one of Nature's methods of eliminating noxious matter from the body, in order 
that it may recover health." 

Miss Nightingale's Hospital Notes. 



98 SHANGHAI HYGIENE 

cent, while in the exposed Hospital Tents in the Crimea 
with scarcely any shelter, with no proper blankets, with no 
proper food or medicine, the amount of mortality was not 
half what it was at Scutari, although there was everything in 
abundance, except good ventilation, and a sufficient territory 
for each bed: and v/hile this appaling number of deaths was 
taking place at Scutari; in the tents of the Castle Hospital 
above Balaclava, patients suffering from the same kind of 
disease, died only at the rate of something under 3 per cent. 
Floating Hospitals have been tried before in Chinese wa- 
ters, and the results were fearful. "In March 1842, the 
Minden, 72, Captain Quin, which had been fitted up as an 
hospital ship, calculated to contain 200 patients, besides the 
crew, and to which Dr. Wilson had been appointed principa 1 
Medical officer, with an adequate staff, was sent out to 
Chusan, where she arrived on the 15th. of August. No 
pains or expense had been spared, to render her in eveiy 
respect suitable for the purpose for which she was intended. 
Nothing was omitted, which in the opinion of the Authorities, 
who ordered and designed the hospital establishment of the 
Minden, could conduce to. the comfort, convenience, and well 
being of the sick and wounded, who might be received into 
it, and it may be unhesitatingly asserted, that no such move- 
able hospital, in respect of magnitude, means of efficiency, 
and completeness, ever left an English port." And yet with 
all the advantages of this fine hospital ship, with everything 
conducive to health and comfort; stationed off Ting-ha3, the 
Capital of Chusan, where it might be considered highly 
favourable to health, a terrible mortality is given. During 
the first three months, the number of deaths on board, was 
more 'than double the number at home during twelve months; 
in other words, the mortality was greater in that Hospital 
ship in 3 months, than among the Home Ibrce in 2 years!. 

It must be I'emembered moreover, that there was no cholera 
epidemic during those three months ; the diseases were fevers, 
diarrhoea and dysentery, like what is found among the ship- 
ping here. After a time the Minden arrived at Hong-kong, 
where, as I have, already said the mortality was from 190- to 
220 per 1000; but when other accomodation was provided 
some years afterwards, it fell to 25 per 1000. 



SHANGHAI HYGIENE. 99 

Under all circumstances there is always a high mortality 
on board HoRpital ships. Our Government uses them as a 
dernier resort, hut the mortality is kept down to some extent 
by sending home invalided patients, who are not likely to 
recover. Nevertheless the mortality is very great; it was so 
last year on board the "Acorn," iu this port; it was great also 
on board the "Melville" at Hong-kong, where many men 
were sent after the taking of Kah-ding, and where they died 
in great numbers. 

The professed objects of an Hospital are, to secure the re- 
covery of the sick in the shortest possible time, and to obtain 
the smallest possible amount of mortality; these objects should 
always be distinctly kept in view, and have the precedence of 
all others. Unfortunately however, they are often lost sight 
of, and other motives and considerations take their place, 
such as realizing the largest profit, for the smallest outlay; 
cheapness, convenience &c. And so long as the construction 
and sites of Hospitals are left to private speculators, or. to 
individuals determined to realize a fortune, abuses will, and 
must remain. Surely in a matter so momentous, as this, — the 
life and health of our fellow cduntrymen, and the health of the 
community, the public ought to make some arrangement, 
whereby the merchant sailor when sick, may be put in cir- 
cumstances where he has a fair chance to regain his health; 
and apart altogether from higher motives,' the public would 
be gainers in the end, even in a mercantile point of view. 

The French have a far higher appreciation, of Hospital hy- 
giene than we have. Their Hospital plans though far from 
perfect are better than ours; they choose better sites, and in- 
stead of permitting private individuals to construct any sort 
of receptacles for the sick, the. Grovemment superintepds 
the plans and arrangements of Hospitals, and are careful 
to study the coihfort and welfare of the patients. The 
Vincennes Hospital may, with the exception of one or two 
defects on the part of the administrative offices, be regarded 
as a model of a Military Hospital. While the splendid Lari- 
boisiere Hospital, may be regarded as an all but perfect speci- 
men of a Civil. The contrast between these Hospitals and 
those of Netley, Chatham, Kings College, and the New Wards 
of Guy's are most striking. 



100 SHANGHAI HYGIENE. 

Two great desiderata are required for Shanghai; and it will 
never he a safe residence for Foreigners till they are supplied. 
1st, A large and well arranged General Hospital, 2nd, A 
commodious and conveniently situated Sanatorium. 

The general Hospital should be built especially for the 
Merchant Service, though it need not be confined to that 
service alone. Policemen and others, who have no proper 
accomodation during sickness, might be sent to it; but uidess 
in certain cases, an hospital is not needed for merchants and 
other gentlemen in Hongs, as they can be sufficiently attended 
to, in- their own houses. The Hospital should be on the plan 
of the Lariboisiere Hospital at Paris, with the same territory, 
and the same number of cubic feet of air for each bed; and 
to contain 500 beds. 

With regard to the Sanatorium, facility of access must be 
a great consideration for men of business : and so far as our 
present knowledge extends, Poo-too, already well spoken of, 
would, all things considered, seem to be the best. The plan 
most promising and practical at Poo-too, would be a com- 
modious, well kept Family Hotel, built on the best and most 
airy site in the Island, with every facility for various kinds of 
amusement, and recreation. Connected with, or near to the 
Hotel, there ought to be a well arranged place for C onvalescents 
from Shanghai — People who having got over their diseases, 
require a change to get up their strength. 

I make these remarks in closing with all earnestness; deeply 
convinced as I am, how much the Foreign Community here 
require a Sanatorium, like that which Poo-too would make. 
And also how much a Greneral Hospital is needed for the Ship- 
ping in this Port. I am convinced, that by this simple, and 
eminently practical means, much disease would be averted, 
better health would be secured, and many lives would be 
saved. I repeat, that with all earnestness, I would urge these 
"General Kemarks" on the consideration of every man in this 
Community, who can raise his voice, or use his influence, to 
preserve the health and lives, and .to promote the best inter- 
ests, and the welfare of his fellow-men. 



A 



<i